Tributes to the Late Chairman of Committees

Baroness Jay of Paddington: My Lords, this has been a very sad week for the House because it has lost two of its most prominent and distinguished Members, Lord Cledwyn of Penrhos and Lord Mackay of Ardbrecknish. Both were admired on all sides of the House for their political success and had warm friends in every part of the House, and it is fitting that we pay tribute to them this afternoon.
	Last Wednesday when we heard of the sudden and untimely death of Lord Mackay there was palpable shock and deep distress among both Peers and members of staff alike. Only the evening before several of us had enjoyed his companionable charm at a reception to honour his appointment as Chairman of Committees. I myself had listened to wonderful stories about his fishing companions and fishing holiday plans told with his usual energetic zest and twinkle, so the next morning's news was particularly unbearable. It is a matter of huge regret that he did not have longer in the role as Chairman of Committees. I feel sure that he would have used his skills in that post to the lasting benefit of the House.
	The list of John Mackay's political achievements is impressive. He was a Member of another place from 1979 until 1987, and for much of that time he sat on the Front Bench as a Parliamentary Under-Secretary of State in the Scottish Office. When he came to this House in 1991 he was first Parliamentary Under-Secretary of State in the Department of Transport and then Minister of State in the Department of Social Security. In opposition after 1997 he was made Deputy Leader and became a key member of the usual channels. While in that role he was voted Peer of the Year in 1998--an honour by which he appeared to be both pleased and amused.
	But he will be remembered as much for the characteristics that he brought to office as for the offices he held. We shall all remember his precise and rigorous mind, which was combined, often to devastating effect, with his concise and articulate delivery. He was a master of the Dispatch Box. Many of us on these Benches were enticed to dance nearer and nearer only to fall into traps that he had set when we had committed ourselves beyond recall. I remember Lord Mackay's glee when during the passage of the Political Parties, Elections and Referendums Bill in the previous Session he uncovered a problem whereby the Bill would have required the leader of a party, which in our case would be the Prime Minister, personally to agree and sign a document every time a constituency treasurer was appointed in a local party. The Government gave in very quickly with as much grace as they could muster and amended the Bill.
	As one of my ministerial colleagues said in the past few days, as a parliamentary debater Lord Mackay could make one smile and look foolish at the same time. Such episodes were meat and drink to him. He had an impish delight in what could be called mischief-making which very much belied the seriousness of the principles and issues which lay beneath his triumphs.
	Lord Mackay's political life and broad friendships were based in Scotland, not least among the group of bright political stars who emerged from the University of Glasgow some 40 years ago. Last October at a similarly sad occasion John found himself paying tribute to Donald Dewar, one of those good friends from college days. He singled out decency as Donald's defining characteristic and went on to say:
	"Donald enjoyed himself, and we enjoyed having him".--[Official Report, 11/10/00; col. 323.]
	Perhaps those are the most fitting words of tribute to John Mackay himself. He was decent; he certainly enjoyed himself, and we enjoyed having him.
	I know that the whole House will join me in sending our deepest sympathy and condolences to John's widow Sheena and to his whole family.

Lord Strathclyde: My Lords, I echo the sentiments of the Leader of the House, particularly on this most sad day when we announce the death of two Members of the House. John Mackay was one of my friends. Although I in particular shall miss his friendship, wisdom and the practical way that he dealt with political problems, I know that his loss will be felt greatly throughout the House and beyond, especially in Scotland where so much of his attention was focused.
	On behalf of the Opposition I join the noble Baroness in offering our deepest condolences to his wife Sheena and to the rest of his family. However terrible and shocking to us the suddenness of his death, it has been a devastating few days for his family. I know how touched and strengthened they will be by the tone of the tributes that have already been expressed. John Mackay was above all a family man who never lost an opportunity to bring his children and grandchildren into debates. Few who heard him will forget how he used what he described as his Italian grandchildren to explain the discrimination against English students at Scottish universities, nor how his daughter who lived in Italy would be able to vote in the referendum in Scotland while his children who lived in England would not.
	John Mackay was one of that breed of politicians who by the way they act give politics and politicians a good name. He had an approach to politics which was, when necessary, highly combative and forensic but was put into effect without ever losing the respect for and of his political opponents. He always acted professionally and was guided by the highest motives to do what he believed to be right. In the pursuit of his objectives his style was never to hector and bully but to persuade and argue the case rationally. That made him an immensely effective Member in your Lordships' House and, before that, in another place.
	The transition from elected politician to this House is not always an easy one, but John made it with great skill and tact. While he never forgot his links and contact with Members of the House of Commons--friends who often inhabited other Benches--he became a House of Lords man, understanding the delicate balances and the nature of this place.
	Although his career was distinguished in another place, it was cut short by his losing his seat. So he joined this House in 1991 where he made a very effective Minister of State at the Department of Social Security, a post which at that time in this House was a real burden. But it was in Opposition that he made such a lasting and deep impression. His interventions from this Dispatch Box were always carefully thought through and designed to have the maximum impact.
	That is why last summer I was so surprised when he approached me to indicate that he was interested in taking on the role of Chairman of Committees. Only after a great deal of thought and consideration did he decide to allow his name to go forward, reasoning that at his age he wanted enough vigour and energy to do his final job well. That was a great loss to these Benches. But, whatever our loss, it would be an immense benefit to the House as a whole at a time of transition. I believe that in the short time he was Chairman of Committees he demonstrated convincingly what an excellent job he would have done for this House over the next few years.
	Of course, politics was not his only love. Fishing for salmon in Scotland was something he enjoyed even more than being here in this House. That, combined with his love and knowledge of Scotland, gave him so much to live for.
	My purpose today is not to sum up all the aspects of Lord Mackay's life, but to pay tribute to and offer reflections on a man I held in the highest esteem and with the greatest affection. All of us in this House feel his loss, but perhaps the most fitting and appropriate tribute is that this loss is felt so widely across the House and transcends all the normal political boundaries. His was a life of public duty and public service. It will be a long time before we see one like him again.

Lord Rodgers of Quarry Bank: My Lords, these Benches would wish to be associated with all that has been said already about John Mackay. It was with a shock close to disbelief that those of us who were here on Wednesday heard first of his illness and then of his death. It was apparent then that it was not only a great loss to the House, but there seemed to be a peculiar unfairness that he should be carried away within 12 hours of the party to celebrate his becoming Chairman of Committees.
	John Mackay was a Liberal candidate in 1964. Indeed, he helped to get David Steel elected in the by-election in 1965. But I did not meet him until he arrived in the House of Commons in 1979. I still remember his maiden speech, made on the second day of the Debate on the Address, mainly for his passion for--what I later learned to be enduring concerns of his--Argyll, very appropriate in so far as it was his constituency, but also salmon fishing, to which reference has already been made. After that, although I detected that he was a considerable political operator, I did not see him until I met him in this House.
	I should like to confirm, because it is the experience of all of us, the very unusual qualities that he brought to debates. He was one of those who enjoyed debate for its own sake, irrespective of the substance. That is not to devalue the arguments and the principles behind him. He was didactic, but that was only, or mainly, to provoke; again a common characteristic of a debater. Then, as others have said, he never took himself too seriously, which many of us too often do.
	He was making the difficult transition, as it seemed to many of us to be, from being a very effective Front Bench spokesman to Chairman of Committees. But he had already demonstrated, I think most effectively, that he would be, as he should be, neutral in the chair. We shall all remember him and miss him greatly.

Lord Craig of Radley: My Lords, on behalf of all Cross-Bench Peers and myself, I add our sincerest condolences and sympathy to the family of Lord Mackay of Ardbrecknish. Words fail to describe adequately the sense of shock and loss which the House has experienced. Well-known and much admired, even maybe politically feared by some, for his trenchant and perceptive handling of business from the then government Front-Bench and, more recently, in opposition, Lord Mackay was much liked and respected on all sides of this House.
	His transition to Chairman of Committees and so to these Benches only a few weeks ago was smooth and full of hope for a period of reforming leadership as Chairman. The evening before his death I had a long conversation with him about some of the issues which he felt were most urgently in need of attention. I, and all on these Benches, greatly regret that he is no longer here to take the helm of revision and reform.
	But our conversation that evening was not all about committees and their structures. I remarked that I had noticed a photograph in the office of the noble Lord, Lord Strathclyde, of the two of them, each sporting a fishing success. Two large healthy looking salmon, held by two large and apparently very healthy and smiling Members of your Lordships' House. Lord Mackay's fish was definitely the larger of the two fish displayed and caught that day on the Tay. But, typically, as I congratulated him on outshining his erstwhile leader, he volunteered that the picture did not reveal the full story. He told me that the noble Lord, Lord Strathclyde, had landed two fine fish to his one. That was surely typical of his generosity of spirit.
	The House will greatly miss his extensive and detailed knowledge of fishing and the whole gamut of issues that surround that troubled and hard-hit industry. But, it is above all the man, his wit, his wisdom, his friendly and approachable nature, his love of politics and of this place, which most of all will be missed. The House has suffered a very great loss of a fine parliamentarian and a charming human being.

The Lord Bishop of Lichfield: My Lords, from these Benches I wish to pay tribute to Lord Mackay. With Scottish blood in my own veins, I always resonated strongly to the power of his Celtic oratory, which I memorably recall once late at night here in this Chamber. He had the ability to inject real adrenaline, as I witnessed, into the debates of the House. I sensed also, as other speakers have said, that he was deeply loyal to his own roots. From these Benches, too, I know that we would want to extend deep sympathy to his wife and to his family in the circumstances of sudden death.

Lord Irvine of Lairg: My Lords, I, too, wish to pay tribute to John Mackay. John was a Scot from Lochgilphead in Argyll. I first met him over 40 years ago at Glasgow University. He was among a unique generation of natural debaters, which included the late John Smith and Donald Dewar as well as Menzies Campbell and Jimmy Gordon, now the noble Lord, Lord Gordon of Strathblane. His hallmarks were acuity, wit, good humour and warmth, which were ever on display in this Chamber. His generosity of spirit most recently stood out in his moving tribute to Donald Dewar.
	As has been remarked, on the evening before his death he attended a party in his honour to celebrate his new role as Chairman of Committees. He was on top form, happy and full of fun. He spoke enthusiastically of Scotland, his planned summer fishing trip there and his forthcoming 40th wedding anniversary. He was a good man, of great personal kindness, liked by all and a splendid companion. He had a talent for friendship across party divides. There was no one better qualified to win the confidence of the whole House in his new role. So, for this House, his premature death is an appalling loss; for his mother, widow and family, for whom we feel deeply, it is a personal tragedy.

Lord Mackie of Benshie: My Lords, I should like to add a short sentence of tribute to the gracious and indeed beautiful tributes already paid to John Mackay. David Steel and I probably knew him as well as anyone, from long ago in the Scottish Liberal Party, where he was a lively and active thorn in the flesh of the management, of which I was unfortunately one. But one could not help admire and see the promise in John. He was an original thinker and, of course, the wit was there already. I was very sorry when he left to join the Tory Party, but I did realise that the Tory Party needed him.
	He had everything that it takes. He had the spark. We have all enjoyed listening to him. We have all been put down by him. We have all tried to get in a dig and never entirely succeeded. I have never been so struck down by a death. It is fate dealing as cruel a blow as ever I saw. He was a man ready to do a job that would have been excellently done. It would have been a credit to this House. It would have done him a great deal of good and would have been a proper finish. To have been struck down is appalling. My sympathy, like the sympathy of all noble Lords, goes to his wife and family. But this House is the poorer; and we all know it.

Earl Russell: My Lords, I once heard Lord Whitelaw remark that one of the things wrong with politics is that so few of us now are friends with our opposite numbers. That reproach was never addressed to Lord Mackay of Ardbrecknish. He was my opposite number for five years. He never gave us an easy time. His defence was so impenetrable that one of his own Back-Benchers nicknamed him "slasher Mackay", after the great Australian stonewaller. But at the same time he was utterly relaxed with anything that any of us could throw at him; he was totally attuned to the mood of the House.
	I remember him once answering a question from the noble Baroness, Lady Castle of Blackburn, on the closure of the Road Research Laboratory. As the noble Baroness's volume grew greater and greater, the noble Lord grew quieter and quieter; a very exact piece of judgment. When we were outside the Chamber, never was there one moment's irritation at having had an extremely hard time inside it. Never was there one moment when he did anything gratuitously annoying to those who were opposite him. And when you least expected it, there was that sudden little serpentine flicker of the tongue, which heralded a joke that left you in helpless laughter. We are all the poorer for his absence and it has been a privilege to serve opposite him.

Tributes to the Late Lord Cledwyn of Penrhos

Baroness Jay of Paddington: My Lords, last Thursday, we faced the less unexpected but nonetheless extremely sad news of Cledwyn's death. Lord Cledwyn of Penrhos, to give him his proper title, was a true political leader, and he was a friend and mentor to so many. His life of public service and his commitment to Wales and to the Labour Party spanned several generations. He was, in the best sense of the word, a tribal politician and, personally, I feel that I have known Cledwyn, in his many wide-ranging roles, for the whole of my adult life. It came as no surprise to me to hear from my father this weekend that he first met Cledwyn in 1949 at the home of Glenys Kinnock's parents.
	As Cledwyn Hughes, it is exactly 50 years ago that he was elected as MP for his home seat of Anglesey, winning a famous election against Lady Megan Lloyd George. When Labour came to power in 1964, he was appointed Minister for Commonwealth Relations. From that role grew a love as well as a deep knowledge of Africa and the African nations, and over two decades Prime Ministers used him to undertake important missions to African states. But it was in 1966 that Cledwyn took up the post he cared most about, as Secretary of State for Wales. Cledwyn's passionate championship of, and love for, all things Welsh were both legendary and obvious to everyone. It was while he was Secretary of State that the Aberfan disaster occurred. As Secretary of State he had to visit and minister to the needs of the bereaved. Those of us who have personally experienced Cledwyn's sympathy will have no doubt that no one could have done that better. But he used to say that this period was the darkest in his ministerial life, and he was personally deeply affected for many years.
	In the 1970s, Cledwyn played an essential role in the Parliamentary Labour Party and became a most distinguished chairman of the PLP in 1974. His skills of organisation and conciliation were crucial to the complicated dynamics of the minority Labour government. In 1979, he came to your Lordships' House and served as Leader of the Opposition for 10 years. He forged a great partnership with, first, Tom Ponsonby as his Chief Whip and later with Ted Graham. Together, they energised the Labour Benches to create an effective opposition, where many of us who are now in government served our apprenticeship on the Front Bench. I know that we all value and remember his kindness and support, his encouraging words in the corridor and his unfailing personal warmth.
	In later years, Cledwyn's devotion to Wales was as strong as ever. His concern was for all aspects of Welsh life, its political and economic advancement and the progress of the university, of which he was deeply proud to be pro-chancellor. He was deeply respected and loved throughout the Principality, culminating in the honour of the freedom of the capital city, Cardiff, last December, just before he became ill.
	I hope your Lordships will allow me, but it was through my father, the noble Lord, Lord Callaghan of Cardiff, that I first knew Cledwyn as a family friend, and he has asked me to add his own tribute this afternoon. He said:
	"I am very sorry not to be present in the Chamber when tribute is paid to Cledwyn's life and work. He was always proud that he had served the state and his fellow countrymen throughout his public life, and in whatever he did he won their trust, respect and even affection. To me, he was a close friend as well as a political ally and for 50 years I had the benefit of his insight, his human sympathy, his negotiating skill and his ever-present humour. At the end of the day, we can truly say he lived a life well spent".
	At this very sad time, our thoughts are with Jean Cledwyn, as well as Anne and Harry. We send them our deepest sympathy.

Lord Strathclyde: My Lords, the noble Lord, Lord Cledwyn of Penrhos, was the Leader of the Opposition when I joined this House in 1986. Much to my surprise, it was not long before he came over to speak to me and to welcome me to this House. I was astonished, but I should not have been, because friendliness and caring for others were two of his greatest strengths.
	Lord Cledwyn held a distinguished record of service in another place, representing for 28 years the constituency of Anglesey. He also played a substantial role in the Cabinet as Secretary of State for Wales and then as Minister of Agriculture, Fisheries and Food.
	Latterly, he served on many voluntary bodies and served on the Political Honours Scrutiny Committee, one of our most important bodies. Naturally, as time went by, he became older and a little frailer, but it would have been foolish to assume that he lacked vigour. He had great intelligence and a capacity for hard work and was admired by the whole House. He was of course delighted with the victory of the Labour Party in the general election of 1997, because he was always an intensely loyal Labour man. Nothing I say should suggest otherwise. However, one could not help feeling that some of the Labour Party's repackaging had slightly passed him by.
	When I became Leader of the Opposition, one of the first things I did was to talk to him. His approach was wise, sensible and pragmatic. I told him how much I had admired his leadership in opposition and, although I think that he was a little surprised at the compliment, he sat down and offered me all kinds of advice. I remember in particular, when I was a young and inexperienced Minister in the early 1990s, how Lord Cledwyn played a great role at Question Time in this House. I shall never forget that terrifying feeling, watching him lumber to his feet to offer a penetrating inquiry which would point out the sheer inadequacy of the ministerial answer. But in doing so, he always kept his humour and perspective.
	He will be remembered with affection by this House. Furthermore, Wales has lost a favoured ambassador, a great son and a champion. Woe betide a Minister who had not done his homework on the effects of legislation in Wales. Lord Cledwyn was a fighter and, while his decline has been sad to witness, he kept on coming here out of a duty to Parliament after a lifetime of service to the Labour Party. On behalf of the Opposition I, too, offer my sincerest condolences to Lady Cledwyn and the rest of the family at this very sad time.

Lord Rodgers of Quarry Bank: My Lords, perhaps I may again associate these Benches with the views which have already been expressed about Cledwyn Hughes. I first met him in 1955 on a trip to Austria. He was extremely kindly and solicitous towards a much younger man. In my experience, that generosity of spirit continued all through the vicissitudes of the intervening years. I certainly always found him good company here. I listened to his advice, took it and indeed asked for it from time to time.
	Lord Cledwyn did not always have an easy political life. He was a mainstream figure, but I remember that in the early 1970s, when he was a very consistent European at a point when his party held to a far less steady course, he did find himself in a minority and, I believe, suffered for that when no place was made available for him in the 1974 government. Despite that, he was never bitter. He had a shrewd sense of politics and a mischievous sense of humour. I do not believe that there is anyone of his generation who was--equally and at the same time--so devoted to Wales and to parliamentary life at Westminster. We shall all remember a long and distinguished life of public service.

Lord Marsh: My Lords, on behalf of these Benches we wish to join in the condolences to a family which always meant more to Cledwyn Hughes than anything else.
	Cledwyn Hughes and I became junior Ministers on the same day in 1964. We entered the Cabinet together two years later. We were both subsequently fired by the same Prime Minister. In my view, Cledwyn Hughes was massively underestimated, both as a Minister and as an extremely effective and, when the need arose, tough parliamentarian and politician.
	Soon after his appointment as Minister of State for Commonwealth Relations, the government were faced with the first of many problems in the Commonwealth at that time; namely, the break-up of the Malaysian Federation, with the possibility of an extremely dangerous confrontation between the Malaysian Prime Minister, Abdul Rahman, and Lee Kuan Yew of Singapore. Cledwyn's boss was one Arthur Bottomley, who will be remembered by some, although we grow fewer in number. Arthur Bottomley was an obsessive globetrotter. As always he was, when this particular problem arose, out of the country. With the tact and timing that was always a feature of Cledwyn, although not often recognised, he realised that this left the door wide open for him to act on the Minister's behalf.
	His success was such that when the Rhodesian crisis erupted, he had already developed a role which made him a significant player in the behind-the-scenes negotiations, as well as opening a direct line to the Prime Minister, Harold Wilson.
	I witnessed an extraordinary example of how close was that relationship on the night of the Aberfan disaster. For those of us who were there, it was an horrendous experience. The disaster resulted in the deaths of 118 children and 28 adults. I was the Minister responsible for the coal industry and Cledwyn was the Secretary of State for Wales. The Prime Minister arrived late in the evening and immediately called a meeting of the officers in charge of the various organisations: the police, the mining authorities and the Army, among others. The Prime Minister opened the meeting with a statement which he had clearly thought out in advance. I hope that noble Lords will bear with me if I quote from Harold Wilson's biography since, in my view, this statement has no precedent:
	"I told the Secretary of State to take complete control of the situation. If anything further could be done, he was to authorise it and to overrule all objections. He was specifically authorised by me to break the law if necessary. We would seek retrospective legislation to deal with it".
	I know of no precedent for any Prime Minister to give that kind of authority to a single Minister and, furthermore, not to suffer dangerously as a result.
	Sadly, however, close relations with Prime Ministers frequently end in tears. Cledwyn was finally removed from office for voting against the government on an issue on which I think he was completely wrong, but in which he believed totally. Typically, he moved on immediately to fulfil a highly successful role as a skilled politician and parliamentarian.
	In common with most of us, I suspect that Cledwyn will not figure prominently in the history books. But in this House we know that, when the fashionable gladiators have had their moment of glory, this stable and successful Parliament--in the future as it has in the past--depends on the contribution of quite a small group of special parliamentarians, of which Cledwyn Hughes was undoubtedly one.

The Lord Bishop of Lichfield: My Lords, from these Benches I must add my own tribute to Lord Cledwyn. It so happens that I also have Welsh blood in my veins. I always warmed deeply to the clarity and detail with which Lord Cledwyn spoke on behalf of his native heath. When I heard him speak, I remember that he had a wonderful stillness and a clear way of disentangling heated argument. Perhaps it was his maturity and experience which enabled him to stand up and disentangle fruitless antagonisms and to find a way through.
	Lord Cledwyn and Lord Mackay had in common a deep loyalty to the pit from which they were dug and to the rock from which they were hewn. I add my sincere condolences to their families.

Sudan: Slavery

Baroness Cox: asked Her Majesty's Government:
	What is their policy with regard to evidence of continuing slavery in Sudan.

Baroness Scotland of Asthal: My Lords, Her Majesty's Government strongly support the efforts of UNICEF and Save the Children Fund (UK) to work with the Government of Sudan to eradicate the practice of abduction of women and children and to return those abducted to their families. We also support the efforts which have been made by the New Sudan Council of Churches. Our ambassador visits the affected areas to drive home the message of our concern to those dealing with the issues on the spot.
	Abduction is a central issue in the EU/Sudan political dialogue and we also raise it regularly at the highest levels in our bilateral contacts with the Government of Sudan. Through the European Union, we give financial support to this difficult and sensitive work.

Baroness Cox: My Lords, I thank the Minister for that Answer. Does she accept that the Government of Sudan have been widely condemned by the United Nations and by many human rights organisations for complicity in slavery? Does she further accept that the measures to which she referred are widely deemed inadequate in terms of the numbers freed compared with the thousands who have been captured and enslaved with the complicity of the Sudanese Government? Can the Minister explain why Her Majesty's Government continue to do business with that regime--even to the point of inviting its Foreign Minister here against the spirit of UN Security Council sanctions--instead of, here in the land of William Wilberforce, taking a lead in the international community to achieve the abolition of slavery in Sudan?

Baroness Scotland of Asthal: My Lords, the Government are taking a role in relation to this issue, and have done so for some considerable time. The abduction of women and children is a serious and distressing issue to which we pay particular attention. Our ambassador raised the issue recently during the EU/Sudan dialogue meeting with the Sudanese Minister of Justice. It was for that reason that those discussions took place. We have a critical dialogue, which is bearing fruit.
	I disagree with the comments of the noble Baroness in relation to the efforts that are currently being made by the Save the Children Fund and others. We are making our way forward. Approximately 560 abductees have been returned, and that is a good thing.

The Lord Bishop of Lichfield: My Lords, given today's press release from the Sudan embassy and the on-going and horrendous conflict between northern Sudan and southern Sudan, which I have witnessed at first hand, can the Minister say whether there is evidence of an enslavement dimension in the struggle as regards the south? If so, what can be done about it?

Baroness Scotland of Asthal: My Lords, this issue has been looked at very broadly. It would be wrong to divide the north and the south in the way suggested by the right reverend Prelate. We are bringing together civil society groups, government groups and the Churches--to which I pay tribute--to try to find a solution which will bring lasting peace to Sudan. Slavery is one aspect alone of a very difficult and complex issue. If we could solve the issue of peace, we would much more quickly solve the issue of abduction.

Lord Archer of Sandwell: My Lords, if, as they insist, the Government of Sudan are not themselves encouraging slavery as an instrument of policy, is there any valid reason why they should not open up the whole of the country to aid workers and to human rights monitors? Will Her Majesty's Government urge them to do that? Until they do, can my noble friend assure the House that the Government will not encourage British companies to invest in Sudan?

Baroness Scotland of Asthal: My Lords, the noble and learned Lord raises a number of issues. Of course it is right that non-governmental agencies should be able to work safely in Sudan. The House will know that there has been a difficult and contentious dialogue between the Government of Sudan and the SPLA, both of whom--to put it at its lowest--have not behaved as one would wish them to on all occasions. We are trying hard to bring about change in this area. It is slow; it is complex; it is difficult and it is at times distressing--but there is a view that we are moving forward.
	As regards business, I heard what the noble and learned Lord said about that. We issue strong advice, and we are happy if people take it.

Lord Avebury: My Lords, does the Minister agree that the Government of Sudan have taken no action against the raids in which civilians are abducted into forced labour and slavery? Does she also agree with the workers' representatives at last year's ILO conference that, while some meek initiatives have been taken, there has been no real progress towards the abolition of forced labour and slavery? Therefore, in her bilateral conversations with the Sudanese, will she encourage them to revoke their refusal to allow an ILO technical mission to visit that country and advise on the further steps which could be taken?

Baroness Scotland of Asthal: My Lords, I can reassure the noble Lord that Her Majesty's Government are taking every opportunity that they can to raise this issue with the Government of Sudan and that we are moving forward in that regard. The issue needs a multilateral approach as opposed to a unilateral one. We are encouraging all those who will join with us in this endeavour to try to make things better.

Lord Alton of Liverpool: My Lords, while I agree with what the noble Baroness has said today--particularly in regard to a multilateral approach--will she return to the answer that she gave to the right reverend Prelate and agree that what is taking place in Sudan today is the deliberate seizure of women and children, in particular, as slaves as a weapon of war? Does she agree that there is a need to create safe havens in the Nuba mountains and in those areas of southern Sudan where the situation is particularly perilous? Does she further agree that the whole House owes a debt of gratitude to the noble Baroness, Lady Cox, for the work that she has done in highlighting these massive violations of human rights?

Baroness Scotland of Asthal: My Lords, I endorse what the noble Lord said in relation to the good work carried out by the noble Baroness. However, I would add a note of caution. We know that there has been a lot of concern about the purchasing of slaves or of those in bonded labour--by whomsoever does so--because it feeds into those who wish to profit from it. Although I entirely endorse what the noble Lord said, I add that caveat.
	The issue is a real one. I have said already that all parties need to come together to try to find a solution. But that solution is not easy; it is complex and it will take time.

Baroness Rawlings: My Lords, do Her Majesty's Government still consider Sudan to be a terrorist state?

Baroness Scotland of Asthal: My Lords, Sudan has had its difficulties. It would be quite wrong to so describe it. We have a critical dialogue with the Government of Sudan. We have to deal with real issues and we are inviting the Sudanese Government to join with us in dealing with those issues, and that will continue.

Works of Art: Indemnity Scheme

Lord Beaumont of Whitley: asked Her Majesty's Government:
	Whether they will amend their indemnity scheme for works of art accepted in lieu of tax so that the works are covered at current value, to enable them to be seen more widely.

Lord McIntosh of Haringey: My Lords, the government indemnity scheme successfully allows museums and galleries in this country to borrow works of art without having to pay for commercial insurance. We are constantly examining ways to increase public access to works of art and all items accepted in lieu are available for public access. I am aware that, since the scheme started in 1980, those items accepted in lieu have been indemnified at their original tax settlement value when on loan. I should like to look again at whether this puts loans unduly at risk and whether it would be possible to amend the scheme so that loans can be indemnified at current market value. I am grateful to the noble Lord, Lord Beaumont, for bringing the matter to our attention.

Lord Beaumont of Whitley: My Lords, I am extremely grateful to the Minister for that Answer. I believe that when he considers the matter he will see that some way has to be found to make works of art more available. I wish the Minister well. I have no supplementary question to ask.

Lord Saatchi: My Lords, perhaps I may add from these Benches our agreement with the view of the noble Lord, Lord Beaumont of Whitley. I hope that the Minister will be able to follow up on his very helpful Answer.

The Civil Service: Training

Lord Hunt of Chesterton: asked Her Majesty's Government:
	How the strategy for the training of civil servants outlined in the Civil Service Reform Programme annual report for 2000 ensures their effectiveness in delivering joined-up government.

Lord Falconer of Thoroton: My Lords, we acknowledge the importance of the joining up of government. We have in place training programmes to improve effectiveness in joined-up service delivery. There is an increased emphasis on the exchange of staff across departments, with an increase of 28 per cent in the past four years. There is a commitment that, by 2005, 75 per cent of senior civil servants will have experience in more than one department. From April 2001, the performance of the top 3,730 civil servants will be judged on a new competency framework which emphasises the importance of collaboration and working across boundaries. We have created cross-cutting units to join up policy development and we have supported this action with changes to budgets.

Lord Hunt of Chesterton: My Lords, I thank the Minister for his reply. However, should not the Government ensure that new recruits to the Civil Service learn more about government and Parliament? Perhaps they should follow the continental practice of having more extended Civil Service training, particularly as many people now entering the service have learnt very little about history, geography or politics at school.

Lord Falconer of Thoroton: My Lords, that is a wide-ranging question. The important point is that people who join the Civil Service should realise that their commitment is to the public service generally rather than to one particular department. That is something that we seek to emphasise both in the competency framework within which civil servants operate and in the training that they receive subsequently--the training being not departmental but frequently cross-departmental.

Baroness Buscombe: My Lords, while I accept and am supportive of a number of the key proposals for reform of the Civil Service, does the Minister agree that it is logical to expect that the development of e-government will mean smaller government? In that case, what steps are the Government taking to adjust recruitment levels across the Civil Service?

Lord Falconer of Thoroton: My Lords, the important thing is to ensure that the Civil Service is able to deliver the public service to a level that the public require. We very much hope that e-government will reduce the size of the Civil Service, but the important point is to focus on the fact that public service delivery is what people expect from central government; and we shall continue to work for that.

Lord Campbell of Croy: My Lords, whatever kind of training is prescribed for the Civil Service, does it not depend on Ministers whether or not government is joined up? As it is the noble and learned Lord, Lord Falconer, who is replying, does he agree that the Dome is not a very good example of joined-up administration?

Lord Falconer of Thoroton: My Lords, I accept entirely that it depends on Ministers. The best way to ensure joined-up government is to ensure that the government of the day have shared objectives which they make clear--as this Government have done. So far as concerns the Dome, I am grateful to the noble Lord for giving me the opportunity to say that it was the most popular paid visitor attraction in the whole country last year, and never fell below an 88 per cent satisfaction record.

Baroness Gardner of Parkes: My Lords, the Minister said that people entering the Civil Service should feel that they belong anywhere rather than in a particular branch. Will he comment on the situation that occurred a year or so ago, when many senior workers in the National Health Service were converted into civil servants? Was that a simple re-naming; or was there a need for a major transition in thinking on the part of those people?

Lord Falconer of Thoroton: My Lords, I said that people in the Civil Service should feel a commitment to the public service, not to an individual department. So far as concerns the noble Baroness's question about the National Health Service, I am not aware of the particular matter to which she refers.

Lord Taylor of Blackburn: My Lords, is it not a fact that these days, as a result of cross-fertilisation between the Civil Service and the private sector, people are continually changing from the Civil Service to the private sector, and from the private sector to the Civil Service? Is not that what is really required?

Lord Falconer of Thoroton: My Lords, interchange is growing in the Civil Service, in the sense that people are moving from inside the service to outside, and are then returning. For example, the current head of Customs and Excise was in the private sector having once been in the Civil Service, and returned to the Civil Service to take up his current post. It is a good practice and it should be encouraged.

Lord Peyton of Yeovil: My Lords, am I right in thinking that by "joined-up government" the Minister means a situation in which Ministers and their departments talk to one another in a comfortable and friendly way? That seems a rather utopian conception.

Lord Falconer of Thoroton: No, my Lords, by "joined-up government" I mean all the departments in government and all government Ministers working towards a set of shared goals.

Lord Harris of Greenwich: My Lords, there are constant suggestions that the size of the Civil Service should be reduced. We have heard one such request this afternoon. Does the noble and learned Lord agree that if one is talking about the size of the Civil Service it might be a good idea to look--as the previous government did not do--at the remarkable expansion in the number of junior Ministers at a time when their responsibilities are being lessened as a result of the existence of executive agencies?

Lord Falconer of Thoroton: My Lords, I do not know whether there has been an expansion or reduction in the number of junior Ministers. I am sure that every single junior Minister in this Government is fully engaged in productive work on behalf of the nation.

Lord Cocks of Hartcliffe: My Lords, does the Minister agree that while people move from one sector to another easily and comfortably, they still want their dustbins emptied? Does he intend to see whether there can be more flexibility in these types of jobs?

Lord Falconer of Thoroton: My Lords, as I said in reply to the noble Baroness, Lady Buscombe, the critical thing that a government, their civil servants and all those engaged in the public service must achieve is public service delivery, in every single aspect.

Savings Strategy

Lord Blackwell: asked Her Majesty's Government:
	What new policies they have in place or are considering to encourage and reward those seeking to save, whether or not for their retirement.

Lord McIntosh of Haringey: My Lords, the Government are encouraging more people to provide for their financial security throughout their lives. The Government's savings strategy is set out in Helping People to Save, published alongside the November 2000 pre-Budget report.
	Already, the Government have introduced individual savings accounts, which have been a resounding success: 8.5 million people invested over £28.4 billion in the first year alone; and in the first six months of ISAs' second year, a further £15 billion was invested. In April, the Government will launch stakeholder pensions, which will widen people's savings opportunities for retirement. These will provide a low-cost and flexible means of saving for those previously denied it.

Lord Blackwell: My Lords, I thank the Minister for that reply. However, will he accept that few of these plans, including the stakeholder pension as now developed, are likely to provide significant encouragement or help for those on low average incomes to save for their retirement and avoid dependence on the state? Will he confirm that over half the population have less than £750 in savings, and that that is a major concern? Against that background, how many people on below average incomes have lost out to the Government's tax on pension funds? Does the Minister agree that the combination of the tax on pension funds and the extension of means testing, in particular through the minimum income guarantee, means that the Government have significantly reduced the incentive for people on modest incomes to save for their retirement and remove their dependence on state help?

Lord McIntosh of Haringey: Yes, my Lords, on the noble Lord's second point I can confirm that far too many people in this country have little, few or no savings. I am not sure whether the noble Lord's figure of £750 is correct, but it sounds about right. However, I do not accept that the Government have not been encouraging those with lower incomes to save for their retirement. In particular, individual savings accounts, to which I alluded in my original Answer, have been conspicuously successful in reaching savers who had never been savers previously. I refer especially to the cash and insurance options that are available.
	As to the abolition of double relief for pension funds in 1997, the effect has not been that which was predicted by the Opposition at the time. On the contrary, it has removed a quite unjustifiable and anomalous temptation for companies to pay out money in dividends rather than encouraging investment in our industry, which is so important for our success.

Lord Northbrook: My Lords, if the Government wish to encourage tax-free saving, can the noble Lord say why the annual tax-free saving amount that existed under the previous government--represented by general PEPs, single-company PEPs and one-fifth of the annual TESSA contribution of £10,000--has been reduced by 30 per cent under the ISA regime to £7,000 per year, and might well have been reduced further had it not been for general protest?

Lord McIntosh of Haringey: My Lords, the noble Lord, Lord Northbrook, is right. We have said that the maximum level in any one year for ISAs should be £7,000 and that it will remain so until the year 2006. As to the total permissible value of TESSAs and PEPs, the noble Lord is aware, like everyone else, that it would not have been sustainable for this Government, or any other, to continue indefinitely with that degree of tax-free investment allowance. At some stage one has to say that that must come to an end. We did so by successfully introducing a new system of ISAs, which, as I said, has reached a far wider range of savers.

Lord Saatchi: My Lords, if the savings ratio has fallen from 10 per cent to 3 per cent over the past three years and the Government are, therefore, having difficulty encouraging savings, does the noble Lord think that it is a good idea to abolish the tax on savings income?

Lord McIntosh of Haringey: My Lords, I do not believe that the noble Lord's comment follows in any way. Yes, it is certainly true that the savings ratios are low, but the ratio is forecast to rise to 4.75 per cent in 2001 and to 6 per cent by 2003. As to the suggestion that we should be exempting from tax all savings income up to the higher rate band, which is what I understand the Conservative Party is advocating, there would indeed be a gain for some taxpayers. However, the richest 10 per cent of the population would receive over 30 per cent of the gain; the richest 20 per cent would receive about 60 per cent of the gain; and about 85 per cent would go to the richest 30 per cent. That is not only inequitable, but also it would not necessarily encourage new savings.

Baroness Gardner of Parkes: My Lords, will the Minister ask his right honourable friend the Chancellor of the Exchequer to do something about the annuity position so that people aged 75 are not forced to put all their money into an annuity which, at present, is subject to very bad rates, only to find that if they die within a day, a week or at any time thereafter they can lose the lot?

Lord McIntosh of Haringey: My Lords, I have today tabled a Written Answer on the subject, the careful wording of which I recommend the noble Baroness to read. It does not rule out any of a number of options that are available to the Chancellor of the Exchequer in the run up to the election. However, it is a complete fallacy to think that it is unfair on people who take out an annuity and then die soon afterwards. The value of annuities is calculated on a basis that is pooled. Some annuity holders will live a shorter time, while others will live longer. It is the average that counts.

Lord Northbrook: My Lords, can the Minister confirm the article in the Observer section of the Financial Times today that the Government are split on this removal of the annuity limit as regards 75 year-olds, and that some members of the Government want this to be removed while others do not?

Lord McIntosh of Haringey: My Lords, I have not read the article. Indeed, if I had, I would not confirm or deny any such speculation.

Business

Lord Carter: My Lords, immediately after the proceedings on the Regulatory Reform Bill, my noble friend Lord Bassam of Brighton will, with the leave of the House, repeat a Statement on criminal justice. This will be followed by a Statement on the foot and mouth outbreak that my noble friend Lady Hayman will, again with the leave of the House, repeat to the House.

Regulatory Reform Bill [H.L.]

Lord Falconer of Thoroton: My Lords, I beg to move that the proceedings of Monday 19th February on the Motion that the Bill do now pass be vacated.
	The Motion is required to vacate the proceedings on the Motion of 19th February that the Regulatory Reform Bill do now pass. Unfortunately, the proceedings on Third Reading were defective to the extent that I did not at that time invite the House to agree to the privilege amendment. Although the Bill itself has no financial effects, it is possible that orders made under it might have. This means that a privilege amendment is required in order not to offend the financial privilege of the House of Commons.
	If your Lordships agree to the Motion, the House will be able to resume its proceedings after Third Reading. I shall invite noble Lords to agree to the privilege amendment. The Bill will then be sent to the Commons.
	Moved, That the proceedings of Monday 19th February on the Motion that the bill do now pass be vacated.--(Lord Falconer of Thoroton.)

Baroness Buscombe: My Lords, I do not know whether this is an appropriate time, but I should like to seek the Minister's assurance that, notwithstanding the proceedings being technically vacated, the substance of the proceedings that took place on 19th February will remain on the record.

Lord Skelmersdale: My Lords, before the Minister responds, I have to say that this shows an element--to say the least--of parliamentary sloppiness on the part of the Government. When, on Second Reading, I described the Bill as an "albatross" round the noble and learned Lord's neck, I did not appreciate that that albatross would be in a slightly different form; namely, cap shaped with pylons.
	As I understand it, this is only the second time in the past 10 years that it has been necessary to move such a rare Motion. In one sense, it is surprising for this Government. On the one hand, they have trumpeted on and on about the supremacy of another place: on the other hand, they have shown a certain amount of arrogance as far as concerns parliamentary proceedings. I do not blame the noble and learned Lord, who, I believe, had other things on his mind at the time. Indeed, for all I know, that is still the case. However, he has had the very able assistance of the Deputy Chief Whip, who jolly well should have known what was going on.

Lord Simon of Glaisdale: My Lords, the Minister got very close to apologising to your Lordships, but in fact we are in his debt. What has happened draws attention to the absurdity of the privilege amendment. It is unique in that it is only moved when what it says is untrue. That is so in the present case. The Companion to the Standing Orders--and this is generally known only to the Front Benchers--says:
	"Nothing in this Act shall impose any charge on the people or on public funds, or vary the amount or incidence of or otherwise alter any such charge in any manner".
	One has only to look at the title to Part I of the Bill to see that it infringes that provision.
	Why do we do it? Until 1972, the House of Commons would not accept a Bill originating in your Lordships' House unless any charge on public funds was merely incidental and subsidiary. Since 1972 they have accepted a Bill which has originated in your Lordships' House even though it imposes primarily a charge on public funds or on the citizen. But it seems to be agreed, although it is not in Standing Orders specifically, that they will only accept a Bill provided that the privilege amendment is passed.
	In fact, the Standing Orders of the other place merely state that a Minister must be in charge of the Bill. On Third Reading the Minister in charge of the Bill says, "I beg to move the privilege amendment". It is not read out; it is not known to the majority of the Members who are assenting to it; and it is passed without debate. In case the taradiddle might be missed by the other place, a thick black line is drawn on the right-hand margin next to the privilege amendment. When it gets to the other place, they merely remove the privilege amendment, which disappears together with its black line, and everyone is perfectly happy. Honour, if that is the right word, is satisfied.
	Why do we do this? There is no particular reason. There are much easier ways of deferring to the financial privilege of the other place. One way would be merely to annex to the message that accompanies the Bill to the other place a note that it is not intended to conflict with their financial privilege. What we have is something that is consistently put in when it does not apply. Even statistics are sometimes not misleading. However, the privilege amendment is invariably misleading. We should really change the old saying to, "There are lies, damned lies, statistics and privilege amendments". This is the very matilda of parliamentary practice. No doubt your Lordships will accede to the noble and learned Lord's half apology and will uphold the Motion. However, I suggest it is a matter that the Procedure Committee might look at again. I happen to know that that appealed at one time to the noble Lord the Chief Whip. Perhaps he will put his great authority behind it.

Lord Falconer of Thoroton: My Lords, of course I give the noble Baroness the assurance that she seeks. I say to the noble Lord, Lord Skelmersdale, that I am responsible for the Bill and therefore I am responsible for the privilege amendment not being moved. I apologise for that but I think he was being unfair to suggest that that showed any kind of contempt for parliamentary procedure. It showed that I had followed advice. I regret that I made the mistake that I did. I apologise for that.
	I am grateful to the noble and learned Lord, Lord Simon of Glaisdale, for his account of the unimportance of the privilege amendment. However, it still has to be moved.

On Question, Motion agreed to.

Regulatory Reform Bill [H.L.]

Lord Falconer of Thoroton: My Lords, I beg to move that further proceedings after Third Reading be resumed.
	Moved, That further proceedings after Third Reading be resumed.--(Lord Falconer of Thoroton.)

On Question, Motion agreed to.

Lord Falconer of Thoroton: My Lords, I beg to move the privilege amendment.

An amendment (privilege) made.

Lord Falconer of Thoroton: My Lords, I beg to move, That the Bill do now pass.
	Moved, That the Bill do now pass.--(Lord Falconer of Thoroton.)
	On Question, Bill passed, and sent to the Commons.

Criminal Justice

Lord Bassam of Brighton: My Lords, with the leave of the House, I should like to repeat a Statement about the Command Paper Criminal Justice: The Way Ahead, copies of which are available in the Vote Office, together with the Criminal Justice System Business Plan for 2001-02 which is being published today. The Statement is as follows:
	"Throughout their period of office the Government have been determined to tackle crime and the causes of crime and to build a criminal justice system which is fair, effective and swift and which commands the full support and confidence of victims and the public.
	"Reducing crime carries wider responsibilities than those of the criminal justice system alone. The Government have invested in a range of cross-cutting programmes which will tackle the underlying causes of crime, including Sure-Start for pre-school children, the new Connexions programme, the Children's Fund, the welfare to work programme and the new National Treatment Agency for drugs. This is a key element in our approach to crime reduction. We are determined not only to deal effectively with crime once committed, but to reduce the numbers of people who turn to crime in the first place.
	"This has to go hand in hand with change in the criminal justice system itself. Here profound improvement is already under way. Following an inquiry under Sir Iain Glidewell, the Crown Prosecution Service has been restructured in line with police force boundaries and a local chief crown prosecutor is now in place for each area. The number of criminal justice units responsible for processing cases to court now co-located with the police is being trebled.
	"The youth justice system is being transformed. The National Youth Justice Board and a network of local youth offending teams are co-ordinating effort against youth crime as never before. Repeat cautioning of juveniles has ended. Graduated court sanctions are helping to ensure that young offenders and their parents take greater responsibility for their behaviour and allow for the active involvement of the victims in the process.
	"From April this year, for the first time police, probation, CPS and magistrates will be operating to the same coterminous boundaries. Statutory partnerships between the police, local councils, the health service and voluntary organisations have been established across the country to ensure that everyone works together effectively to reduce crime and disorder. These partnerships are benefiting from significant investment under a three-year crime reduction programme--including the biggest ever expansion of CCTV--to help drive crime down at a local level. New anti-social behaviour orders have removed a climate of fear and intimidation from many neighbourhoods, while more than 1,100 successful prosecutions have taken place for new offences of racial violence and racial harassment.
	"The system for community punishments is being reformed to ensure better enforcement by a new national probation service. The Prison Service is investing large sums into drugs prevention, accredited offending behaviour programmes, better education and training and an extra 2,660 prison places. This strategy is bearing fruit. Against demographic projections that crime would rise in this period, the British Crime Survey shows that from 1997 to the end of 1999 overall crime had fallen by 10 per cent, with reductions of 4 per cent for violent crime, 15 per cent for vehicle crime and 21 per cent for domestic burglary. Since 1997 overall recorded crime has fallen 7 per cent to a total of just over 5.2 million offences with reductions of 28 per cent for domestic burglary and 20 per cent for vehicle crime.
	"I pay tribute to the efforts, commitment and dedication of the police, all those who work in the other criminal justice service agencies and the host of volunteers in Victim Support, Neighbourhood Watch and many other local organisations.
	"These recent improvements have, however, taken place in the context of more fundamental and deep-seated problems.
	"Over the past 20 years the performance of the CJS has not kept pace with long-term trends in crime, nor with new types of crime: too few crimes are detected and prosecuted successfully. Between 1980 and 1995, while the number of recorded offences doubled, the number of convictions in respect of those offences fell by a third. Plainly the system is not as successful as it should be in catching, prosecuting and punishing the criminal.
	"Cases still take too long, while sentencing is too variable and insufficiently focused on reducing re-offending. Within two years of starting a community sentence, or finishing their prison sentence, over half of offenders will be back in court to be convicted and sentenced for further offences.
	"The legacy of these failures is that crime is still far too high here, not just in comparison with levels 20 years ago, but also compared with other Western countries. The British Crime Survey showed that while violent crime has fallen by 4 per cent, there are worrying increases in street crime, including robbery.
	"With this Command Paper the Government are tackling these longer-term problems. Alongside our continuing programme set in place over the past four years, the paper describes our further strategy for reducing crime and reforming the criminal justice system. It describes a demanding programme for delivering the targets set out in the CJS Public Service Agreement, and also identifies a wide range of new areas where we are looking for improvements. These are focused on four key themes: first, crime prevention--dealing with those factors which appear to increase the chances of a person getting into crime; secondly, catching and convicting more offenders, especially persistent offenders--to close the 'justice gap' between crimes reported to the police and those resulting in a criminal being brought to justice; thirdly, ensuring that punishments fit the criminal as well as the crime, thus reducing re-offending and crime; and, fourthly, radically improved treatment for victims, to ensure that their need for information, support and advice is better met at every stage of the criminal justice process.
	"Research that we have undertaken shows that a small group of hard core, highly persistent offenders, fluid but probably no more than 100,000 strong at any given time, may be responsible for half of all crime. Our strategy, involving both investment and reform, is therefore intended to help catch and convict more of these serious and persistent offenders, and to do so more often.
	"Using the extra resources and further new technology and techniques, the police will give priority to these serious and persistent offenders. The entire active criminal population will be on the DNA database by 2004. The national intelligence model will be adopted by every police force to establish a consistent basis for gathering, sharing and using intelligence. In addition to previously announced measures to increase the number of police officers to the highest ever level by March 2003, the document details proposals to improve detective capability, and leadership and the management of senior careers in the police service, and to enhance the prospects of those who make a career of being a front-line constable.
	"As a whole, the CJS will be receiving the biggest injection of new resources in 20 years. This will deliver more staff, more capacity, and the modernisation of information technology systems for all those working in the CJS. A 23 per cent real term rise in funding for 2001-02 will enable the CPS to recruit scores of extra prosecutors, remedying the under-funding of the service when it was first set up.
	"But with this investment and reform must come results. There will therefore be a CJS-wide target for 2004 to increase by 100,000 the number of recorded crimes ending in an offender being brought to justice.
	"The document also sets out why we also want to consider fully and carefully the scope for improving court organisation and procedures, the rules of evidence, and codifying and clarifying the criminal law itself. So in December 1999 we asked Sir Robin Auld to conduct a comprehensive and independent review of the criminal courts. The Government will take final decisions after carefully considering his recommendations.
	"To achieve our broad goal, of punishments which fit the criminal as well as the crime, we will reform radically the present sentencing structure. This will be based on preventing reoffending as well as punishment and will ensure that persistent offending leads to an increased severity of punishment. There will be a new approach to community punishments and far better enforcement. From April the new National Probation Service will have its funding increased by over a fifth--22 per cent--in real terms over the next three years to deliver a 5 per cent reduction in reoffending. There will, for the first time, be proper supervision of short-sentence prisoners after their release, and a new emphasis on sentence management and review. In making final decisions in this area we shall take full account of the review of the sentencing framework under Mr John Halliday, a senior Home Office official.
	"To deal with young offenders there will be a range of new measures, including a commitment that every young offender in custody will get a minimum of 30 hours a week education, training or similar development work.
	"Many of the 100,000 most persistent offenders are hard drug users. We therefore have to target better our efforts to break the link between drugs and crime. New measures include the introduction nationally of drug treatment and testing orders. There will be more referrals into treatment at the point of arrest, and drug testing at the point of charge, to ensure that we identify drug misuse problems and intervene earlier. Over the next three years, spending on drug treatment will rise by 70 per cent to over £400 million. And there will be more money to help educate prisoners and ensure that they are able to get work on release.
	"Finally, as regards victims and witnesses, support for victims in the UK is already high by international standards and we have the most generous criminal injuries compensation scheme in the world. But the Government are determined to do still more to deliver a better deal for victims and witnesses. I will therefore tomorrow be publishing a consultation paper which will include details of our proposals for a new charter of victims' rights and a victims' ombudsman. This includes a commitment to make sure victims are kept properly informed throughout the progress of their case.
	"We want the CJS and everyone working within it to focus on two clear and linked outcomes: the delivery of justice and the reduction of crime. That is the goal of the programme which I have set out today. I commend the Command Paper to the House".
	My Lords, that concludes the Statement.

Lord Cope of Berkeley: My Lords, clearly none of us has had the opportunity to study properly the Command Paper; the business plan is not yet available. Can the Minister confirm that the Statement--it has an obvious pre-election flavour--and the Command Paper owe little to any new proposals? They owe a great deal to the fact that spin doctors have spotted the Government's poor performance on crime, to use the words of Mr Justin Russell, the Home Secretary's political adviser. Are the words of Mr Russell, as quoted in the Sunday Times, accurate?
	The main purpose seems to be to make headlines; and that was achieved towards the end of last week. However, some of those headlines have not materialised in the Command Paper. Others appear only in consultative form. Is that because the Home Office lost the battle with the Treasury about which we also read in the newspapers over the weekend?
	We have had a deluge of Home Office Bills in the past Session. The few firm proposals in this document are not in the Criminal Justice and Police Bill which is now before Parliament, as are several other Home Office Bills. Am I correct in thinking that the Home Office research published before Christmas on lay and stipendiary magistrates will not now result in an important shift of work away from lay magistrates? Why has the Home Office said that the Government will reform radically the present sentencing structure? The Statement indicates that the Government are waiting for the report from Mr Halliday before doing so.
	Does the Minister think that the newspapers were right to report that the sentencing reform--when it comes--will mean a cut in prison sentences for tens of thousands of prisoners? The fond hope is that outside prison at least some prisoners will get the training that they ought to get inside prison, although I am not sure that releasing them will improve the chances of that.
	Similarly, there are many references to court organisation, but we have to wait for the report of Sir Robin Auld before we hear anything positive on that. Will the Minister spell out a little further the proposals to enhance the prospects of those who make a career of being a front-line constable? Will they be paid more than constables who work somewhere other than in the front line of the police service?
	What is all this that we read about judges supervising rehabilitation? It was mentioned a lot in the papers, but it is a bit vaguer in the document.
	Victims got a mention at the end of the Statement, with a reference to a consultation paper being issued tomorrow. Will that consultation paper rephrase the promises that Labour made before the last election? That seems to be the indication, but we may have to wait until tomorrow to find out about that.
	Since this Government came to office, there has been a surplus of proposals and a lack of performance. I am not alone in thinking that, instead of producing great blocks of glossy paper recycling promises, the Government should concentrate on delivering on the promises that they have already made.

Lord Goodhart: My Lords, there is a good deal in the Statement that we welcome, but I have some queries and comments to raise. First, the Government say that the British Crime Survey shows that from 1997 to the end of 1999, overall crime had fallen. Is not that the continuation of an existing trend, not only in this country, but in many others in the developed world? It is not peculiar to this country.
	The Statement says that, in addition to previously announced measures, the Government will increase the number of police officers to the highest ever level by March 2003. One wonders what figure the Government have in mind. They talk about 9,000 extra new recruits, but what will the outcome be? Will the number of police officers be significantly above the highest previous level, and if so, by how much?
	Have the Government considered the proposal put forward by my honourable friend Mr Simon Hughes for community safety forces, which would co-ordinate and expand the work now done by traffic wardens, park wardens and others to deal with matters such as litter, relatively minor acts of vandalism and graffiti, thereby releasing the police for more serious work?
	We welcome the long overdue substantial real increase in funding for the Crown Prosecution Service. I hope that it will improve the efficiency and morale of the CPS. However, I am a little worried by the comment in the Statement that there will be a CJS-wide target for 2004 to increase by 100,000 the number of recorded crimes ending in an offender being brought to justice. Obviously we hope that there will be a substantial increase in the number of prosecutions resulting in conviction, but specific targets worry us. We all know about the alleged cases of traffic wardens who are supposed to fulfil a specific target. We do not think that that is a good idea. We welcome the increase in the work of the CPS, but we are worried about the targets.
	The Statement then refers to considering the scope for improving, among other things, the rules of evidence. I do not for a moment suggest that the rules of evidence are immutable and cannot be changed or improved--quite plainly they can. However, the Command Paper includes suggestions on changing the rules about the disclosure of unused prosecution evidence. Many of the most serious miscarriages of justice in the past have arisen from a failure to disclose prosecution evidence that has not been used. We would want to look carefully at any proposals to restrict the disclosure of unused prosecution evidence.
	The Command Paper also says that the Police and Criminal Evidence Act 1984,
	"gives the court discretion to exclude evidence which has been improperly obtained, if admitting such evidence would have an adverse effect on the fairness of the proceedings".
	It goes on to say:
	"It has been suggested that the operation of the section 78 test should be reviewed and the Government will consider this".
	What does that mean? Are the Government suggesting that the Section 78 test under the 1984 Act should be weakened to allow evidence to be admitted even if it would have an adverse effect on the fairness of the proceedings? That would worry us very greatly.
	The Command Paper also says:
	"One option for simplification would be to allow evidence of previous convictions where relevant, providing their prejudicial effect does not outweigh their probative value".
	That is more easily said than done and any such proposal would need to be looked at very carefully.
	The Command Paper refers to alcohol abuse, although the Statement did not. The misuse of alcohol is undoubtedly a major source of crime. It is no coincidence that, along with our very high rates of alcohol consumption in this country, particularly by young people, we have considerably higher crime levels than many other European Union nations. Will the Government consider a campaign against alcohol abuse that is as serious as their campaign against the abuse of other drugs?
	We welcome the Statement. There will be more money to help educate prisoners and ensure that they are able to get work on release. We strongly support that. We believe that there should be a working day programme to ensure that prisoners are in work or training for 35 hours a week--that is substantially more than at present. We also suggest an increase in prison wages, not to allow the prisoners to spend more in prison, but to provide a pool from which compensation can be paid or help can be provided for victim support schemes, and to provide a sum that will give released prisoners some money to keep themselves going through the very difficult first few weeks after they come out of prison. We welcome the reference to the criminal injuries compensation scheme, but, while the Government are undoubtedly correct in saying that it is generous compared with other countries, recent cases, particularly that of Lisa Potts, have shown that there are serious problems with it, particularly the rule that in the case of multiple injuries, compensation is payable on only the most serious and the rest must be ignored. That seems illogical.
	We look forward with great interest to the proposals to be published tomorrow for the new charter of victims' rights and the victims ombudsman. We strongly welcome the improvements in the Command Paper on that important issue.

Lord Bassam of Brighton: My Lords, noble Lords opposite have raised a number of useful and interesting points. I do not believe that our Government have lost the will to fight crime; nor have we lost the battle of ideas in this field. I believe that the document published today provides ample examples to that effect. It has little or nothing to do with the fact that a general election may or may not be approaching. It has much to do with providing a clear sense of purpose for the criminal justice system over the next 10 years. Our document is full of new ideas--ideas which emanate from wherever is necessary. We are a Government driven by ideas, thinking and practical problem-solving. That is the way in which we operate and that is where we are in government.
	I shall run through a few of those ideas. With regard to policing, we say that we want to enhance detective capability. It is very sad that, when in power, the party opposite ran down the quality of detective training. We say that we want to bring in new, outside experience from the public or private sectors to enhance detective capability. That seems to me a sensible, pragmatic way in which to approach the matter. No doubt it will be much welcomed by the police service. We say that we want to create a new joint central body to set out service-wide strategic approaches to information technology and to scientific and technical developments. That is a new idea.
	We say that we want a more structured career management process to be put in place, including the development of a new leadership development board. That is a new idea. We say that we want to explore the scope of specialist court hearings to deal with drug dealers. That is a new idea. We say that we want to see continued and better oversight and intervention by the criminal justice system in drug abuse matters generally. We say that we want to develop specialist prosecutors. We say that we want to have a consolidated criminal code. I could go on with a long list of the new approaches and ideas that are contained in this document.
	As to losing a battle with the Treasury, I believe that I made it plain in the Statement that we are increasing significantly resources to all parts of the criminal justice system. Those resources were much depleted in many spheres during the watch of the previous government. We are putting more money into the Prison Service and the National Probation Service. By 2003, record numbers of police officers will be serving the nation. They will be on the streets and in the places and communities where they need to be.
	In the Statement I touched on the forthcoming report from Sir Robin Auld, who is doing a sterling job. We shall obviously take careful note of his comments, not least those he might make about the future of the magistracy. On page 64 of the report we make plain how greatly we value the magistracy and how we wish to see its role continue much as it is. Of course, we accept that it must adapt to modern circumstances in order to deal with new situations as and when they arise.
	The noble Lord, Lord Cope, asked about the role and development of the constable. Constables make up approximately 75 per cent of the front-line service. We greatly value their work and want to enhance that work in the community. That is obviously a shared objective across the three major parties. We want to enhance the status of constables in the very active, important and visible community role that they perform, and we want to explore with the service how that may work.
	Tomorrow we shall publish a consultation document. Both noble Lords drew attention to that. We want to strengthen the position of the victim within our criminal justice system. I pay tribute to earlier administrations, not least the Labour administration which, some 35 or 36 years ago in the early stage of our administration in the 1960s, set up the criminal injuries compensation process. I also pay tribute to those who have enhanced the system during their watch. However, we want to go further than that. When examining the criminal justice system, we want to ensure that the victim is at the centre of our concerns and considerations.
	The noble Lord, Lord Goodhart, referred to patterns of criminality. It is true that varying rates of criminal activity are to be found across the world and that crime patterns vary. We are pleased that, according to the BCS, there has been a 10 per cent reduction in crime in the period since 1997 and a 7 per cent reduction in recorded crime figures. We want that reduction to continue. At the heart of our approach is a strategy which is designed to reduce crime. I hope that that will be generally welcomed and supported.
	The noble Lord asked a specific question about police numbers. We estimate that police numbers will reach approximately 126,000 by March 2001, approximately 128,000 by March 2002, and the highest ever level during 2003-04. Clearly that final figure will depend very much on the continued success of the recruitment campaign. However, I can tell your Lordships that across the country numbers in police training colleges are now 74 per cent higher than they were this time last year. I believe that that gives a fair indication of where we expect the numbers to be moving during the coming period.
	The noble Lord also referred to funding for the CPS. The CPS was set up in 1985. At that time, we argued that we were concerned about the basis on which it was to be established and about its resource levels. Despite the tireless efforts of those involved in it, when we came into government we inherited a situation in which the service was perhaps not performing at its best. For that reason, we have given it further funding through the spending review process. As I understand it, next year the service will receive an increase of 23 per cent in funding. We consider that to be a significant sum of money and one which will enable us to meet the targets revealed today.
	Although I understand the concern expressed by the noble Lord, Lord Goodhart, about simple target-setting, we believe that it is right that more people are brought to book. The fact is that since we have been in government we have seen a 13 per cent increase in the number of convictions. We are delighted about that. We believe that with extra resources the CPS will be able to increase the number of convictions by approximately 30 per cent. We consider that to be important. People want to see criminals brought to book; they want to see the criminal justice system working well; and they want to have confidence and reassurance from it. We in government believe that that is right and we support that desire.
	The noble Lord, Lord Goodhart, made a point about previous convictions being taken into consideration. Of course, this is a sensitive area and we respect the point which the noble Lord made. However, matters will be left very much to the discretion of the judge, and no doubt this is an issue on which Sir Robin Auld will comment. I consider it to be a very important point.
	I have covered a range of the points which were made in the opening responses of noble Lords opposite. It may be worth reiterating that the increase in funding for the CPS will be in the region of 23 per cent in the period 2001-02. That further underlines the point that I made earlier and I hope that it is helpful. I look forward to receiving questions from other noble Lords during this Session.

Lord Elton: My Lords, as one who is particularly interested in young people before they become, as well as when they are, criminals, perhaps I may ask a few questions about the key points listed on pages 27 and 28 of the report. First, I see that 400 additional secure training centre places are to provide intensive supervision and so on. Recently I visited Medway. Together with colleagues who went there, I came to the conclusion fairly quickly that in part the place depended for its effectiveness on its small size. I should like to know how many more secure training centres are to be built to accommodate the extra 400 people. If it is merely a question of squeezing them into existing accommodation or expanding that accommodation, that will be counter-productive.
	My second question is about the new children's fund and the associated £450 million. Where is that money coming from? Is it being taken from other programmes or is it new money? More particularly, what proportion of it will be devoted to supporting the voluntary sector that works to prevent young people from getting into crime? My view, which is based on considerable experience, is that that is infinitely the most effective arm that we have. If it is possible at this early stage to say how voluntary agencies could apply for those funds, that would be helpful.
	The report states that there is to be,
	"Better provision for excluded pupils, including a target"--
	that word always heralds an election--
	"to ensure that all permanently excluded children receive full time education by 2002".
	That will cost big money. Many of those children can be taught only two-to-three or even one-to-one. How many such children are there, what will it cost to take the proposed action and, if every school in a local authority area has refused to receive those children, where will it be done? Will there be a new institution and, if so, can we be told about it?
	Finally, I notice that the report states that there is to be,
	"Funding for an extra 2,660 prison places and significantly more investment in employment placements, basic skills training, offending behaviour programmes and drug treatment in prison".
	That is a basket of oranges and eggs. Places cost capital but programmes cost recurrent expenditure. What is the breakdown between those two approaches, and what is the total sum that will be devoted to them?

Lord Bassam of Brighton: My Lords, the noble Lord asks some valuable questions. In view of his great knowledge of these matters, I always expect him to do so on such occasions.
	On the noble Lord's question about secure training centres, I completely agree with him. In a sense, small is beautiful in that context. It enables greater concentration on the individual circumstances and problems that young offenders confront. Today, on one of my visits, I met someone who had recently returned from the Medway centre, which, he disclosed to me, had provided him with considerable hope for the future, important training and help with his personal development. For those reasons if not others, I support the development of secure training centre places.
	As I understand the situation, the number of sites will be driven by the number of places that we seek to establish. Roughly speaking, most of the centres have in the order of 40 places. I hope that that gives the noble Lord some idea of the number of additional sites that we may need to develop in order to secure the 400 additional places. I am happy to do further research into our plans in that regard and shall further inform the noble Lord.
	The noble Lord asked about the children's fund. That involves money that has been announced before, although it was obviously new money when it was announced. That is how things are supposed to be. The announcement has already been made in part. That new and important development clearly contributes to our overall strategy because it will provide a range of services through the voluntary and statutory sectors, which will assist young children.
	The noble Lord asked how voluntary agencies could apply. There will be an announcement about that. I believe that the children's fund will come on stream from April this year.
	The noble Lord also discussed excluded children and the Government's view of the importance of securing full-time education for those children. That is important. The Secretary of State for Education has given a commitment about that and about funding the extra work that will be expected of schools to ensure that as many children as possible, who might previously have been excluded, will remain within the education system.
	The noble Lord also commented on our investment in the Prison Service. We make no apology for that. We recognise the importance of drug treatment and testing. For that reason, we are seeking to purchase and acquire more relevant spaces and places. The noble Lord said that the report's approach involved a basket of eggs and oranges. There is more coherence in the approach than he suggested. Yes, there will be offender treatment programmes, drug treatment programmes and a commitment to ensuring that there is training, which will ensure that when people come out of prison they have a reasonable expectation of returning to the world of work.

Lord Elton: My Lords, my question was about funding the programme.

Lord Bassam of Brighton: My Lords, the funding for those important developments is from the spending review. It has already been put in place and is secured.

Lord Ackner: My Lords, I had assumed that it was common ground that overcrowding is the biggest single corrosive factor to prison administration, but that problem does not feature prominently in the report. Is the Minister aware that in many prisons overcrowding is undermining the Prison Service's attempts to deal with reoffending? Is he aware that despite an extensive prison-building programme, more than 12,000 prisoners are held in overcrowded cells and some prisons have overcrowding of as much as 80 per cent? I expect that the Minister will accept that as a result of that problem about 25,000 prisoners are held more than 50 miles from their homes. That means that family relationships are disrupted and that effective resettlement is more difficult.
	I also take it that the Minister is aware that during 1999-2000, just 7 per cent of the average daily prison population completed an accredited offending behaviour programme. Prisoners now receive just 10 more minutes a day of purposeful activity compared with the figures of 10 years ago, despite the extra money that the Prison Service has received. Does the Minister accept that it remains the case that only a minority of prisoners benefits from programmes that are designed to reduce their propensity to reoffend?
	Such matters are being carefully recorded by the Prison Reform Trust. My noble and learned friend the Lord Chief Justice referred in a recent speech to overcrowding being analogous to AIDS. Others have referred to it as a cancer or a severely dangerous disease. What does the Minister propose to do about overcrowding? How will it be reduced and in what way?

Lord Bassam of Brighton: My Lords, I thought that I had made it plain that we were seeking to secure an extra 2,660 prison places and that there is a prison-building programme to match that target. I take the noble and learned Lord's point and those made by the Prison Reform Trust. We had a related debate in your Lordships' House only last week and questions are asked regularly on this issue. We take overcrowding very seriously. It is perhaps worth pointing out that back in 1991, some 30 per cent of prisoners--one in three--were in overcrowded cells, and trebling or doubling was involved. The administration of the day decided that that was unacceptable and commenced a prison-building programme to try to reduce that number. We share that objective. Since we have been in government, overcrowding has reduced to 14.6 per cent. But I accept that there is more to be done.
	I do not believe that overcrowding is either right or appropriate. But given that the prison population has been rising, that it is important that we have a facility for custodial sentences and that that is again a shared objective, we expect that over time we will be able to reduce overcrowding.
	The noble and learned Lord made some important points in relation to the value of education. I greatly regret the fact that during the last administration insufficient was invested in education. It is for that reason we are beginning to invest more in education services within the prison estate and for young offenders. Our target is for young offenders each to benefit from 30 hours' education every week. We believe that training and education can make a major contribution to ensuring that people have real choices and opportunities when they come out of prison.
	Offending behaviour programmes have been fully financed in the current spending review. The settlement provides for £17 million to deliver 9,000 accredited programme places aimed at reducing re-offending. The programmes will be accredited by the Joint Accreditation Panel. Those are important commitments. We must improve on our current record and we want to do so. We hope that we are supported in that. It can clearly make a major contribution to reducing offending. One of the core purposes of the Government is to reduce rates of offending when people come out of prison and when they end their sentences, however they are served.

Lord Borrie: My Lords, my noble friend is well aware of the great public concern that there should be a more visible presence of uniformed police on the streets. I should therefore like to follow up the earlier query of the noble Lord, Lord Goodhart. He referred to uniformed traffic wardens and others who, with suitable additional training, could deal with quite a lot of what he called "lower order" crime.
	Is my noble friend aware that last week the organisation, London First, made a presentation in the presence of the Metropolitan Police Commissioner and the chairman of the Metropolitan Police Committee, in which the commissioner welcomed that sort of development in which his force could be involved? He referred to a number of pilot studies in other parts of the country where such schemes had been found to be useful in providing figures of authority which could be both a deterrent to crime and a force with which to deal with lower order crime.

Lord Bassam of Brighton: My Lords, I am grateful to my noble friend Lord Borrie for raising that subject again. I am aware of that presentation. I know that it was well received. Members of the public generally find a uniformed presence, in whatever shape it comes, reassuring. Although traffic wardens are not always as popular as we would like, the public also find their presence reassuring.
	The Government actively support the development of neighbourhood wardens. I have visited a number of neighbourhood warden projects. They too offer a measure of reassurance. Indeed, I commend Tameside's neighbourhood warden system, a uniformed force which works closely with the police and is actively supported by them. We have invested more into the neighbourhood warden services.
	The points made by the noble Lord, Lord Goodhart, and my noble friend Lord Borrie were extremely helpful. We are of course open to imaginative uses of those who provide patrolling and supervisory services, whether they be park keepers, park constables, who have a wide range of responsibilities, or park wardens. They can all have an important impact on levels of minor crime. Those were helpful contributions and we want to see more such schemes in operation.

Lord Thomas of Gresford: My Lords, can the Minister tell us whether the new charter of victims' rights will contain provisions for restoring the measure of compensation which an earlier Labour government introduced in the 1960s? As he rightly said, that government established the compensation scheme based upon the measure of damages payable at common law. The Minister referred to the successor government enhancing that scheme. They did not enhance it; they destroyed it. They cut the level of funding by half and at that time, in 1993, the loudest in attacking those proposals was the then shadow Home Secretary, Mr Tony Blair.
	The White Paper said that the Government are determined to do still more to deliver a better deal for victims and witnesses, including the large number of victims of crimes which are never solved. It also makes clear that the level of clear-up dropped from 40 per cent in 1980 to 24 per cent at the present time. That means that 76 per cent of victims never have the opportunity of being informed of the progress of their case, because there is no case. They never have the opportunity of submitting a victim's personal statement to the courts or of tracking their case. Will the Minister confirm that proper compensation will now be paid to the victims of crime as originally envisaged by his own party?

Lord Bassam of Brighton: My Lords, the noble Lord, Lord Thomas, is right that we were extremely critical of the Howard changes and were vociferous in our criticism at the time. We believe that compensation is right. For that reason, one of the elements of the package we are considering today is to establish a victims' fund which will be additional to the compensation process.
	I cannot make a commitment from this Dispatch Box today that we will be restoring the criminal injuries compensation arrangements to what they were in the early 1990s. We have moved on from there. But we recognise that improvements can still be made.
	Since we have been in government, we have done much else to support witnesses and victims. A witness services scheme is now in place at all 84 Crown Court centres. It is run by Victim Support. The service is being replicated by magistrates' courts and by March 2001 such a service will be provided in 40 per cent of magistrates' courts. We expect coverage to be achieved completely by March 2002. Since we have been in government--to give another example of our support for victims--we have seen the largest ever grant increase; that is, another 50 per cent funding for Victim Support's schemes nationally. We have also put more money into support after murder and manslaughter.
	Those are significant changes. We expect to build on them. For that reason we will be publishing a consultation paper tomorrow in which more detail will be set out for people to assess. That is testament to our support for the interest and concern of victims. We welcome thinking from all parties on that. Again, it should be a shared objective to ensure that victims and witnesses are at the centre of our thinking in the criminal justice process.

The Lord Bishop of Lichfield: My Lords, I wish to ask the Minister about the issue of families of people in prison.

Foot and Mouth Disease

Baroness Hayman: My Lords, I apologise to the right reverend Prelate but I think that the time for the previous Statement has expired.
	With the leave of the House I should like to repeat a Statement being made by my right honourable friend the Minister of Agriculture in another place about the outbreak of foot and mouth disease. The Statement is as follows:
	"As my right honourable and noble friend Baroness Hayman reported on 21st February, the first case of foot and mouth disease in the United Kingdom for 20 years was confirmed on the evening of last Tuesday, 20th February, in pigs at an abattoir and in cattle on a neighbouring farm near Brentwood in Essex.
	"The number of confirmed foot and mouth disease cases rose to nine this morning. Three further cases, bringing the total to 12, have been confirmed early this afternoon. Today's cases are: first, in sheep at Hatherleigh near Okehampton, Devon, at another farm in the same ownership as the one confirmed yesterday; at Bromham, near Chippenham, Wiltshire, in sheep at an abattoir which received animals from the Devon source; in a farm between the two cases in Northumberland, which is likely to have been windborne spread; at a farm near the Welsh border in Herefordshire which had also received sheep from Devon, and at a further farm in Devon linked to the Hatherleigh case. Infected area restrictions are being imposed. A decision was taken at lunchtime today to kill the remaining animals on the several premises in Devon under the same ownership, and on one neighbouring farm, as dangerous contacts.
	"Investigations are continuing into a number of other premises where there is reason to believe there may be disease. The Government's overriding priority is the containment and eradication of this disease.
	"On 21st February, the United Kingdom Government and the European Commission acted swiftly to prohibit temporarily the export of live animals, meat, fresh milk and other animal products from the United Kingdom. Given the acutely infectious nature of foot and mouth disease, this was a necessary step in helping to prevent the spread of the disease to other countries. We are able to export non-susceptible animals and their products provided they meet certain conditions and are accompanied by veterinary certificates. Appropriate certificates are now available for issue from MAFF animal health offices.
	"We immediately ceased issuing export health certificates for export to third countries for any animals or products which cannot also be exported to other EU member states. This applies whether or not the import conditions for a given country would allow us to export.
	"We are urgently tracing all exports of FMD susceptible animals from areas under suspicion to other member states since 1st February but before the export ban came into effect. The EU Commission has been kept informed at every stage, along with our EU partners. I shall be updating the Council of Agriculture Ministers tomorrow. In particular we advised the German authorities of a consignment of sheep from the Devon outbreak and these were slaughtered by the German authorities yesterday.
	"Some of the cases have been on premises which are associated with substantial movement of animals. The confirmation of the cases in Northumberland on Friday 23rd February showed that the disease was not confined to Essex and had been in the country longer than had at first been apparent. In these new circumstances, the Chief Veterinary Officer advised that stringent controls were needed. After discussion with the food and farming industries, and with the devolved administrations, I announced later on Friday 23rd February that there should be a seven-day standstill of livestock movements throughout Great Britain. This exceptional measure was imposed at 5 p.m. on Friday, and is due to expire at midnight this Friday 2nd March.
	"The Department of Health and the Food Standards Agency have confirmed that foot and mouth disease has no implications for human health or food. The disease causes serious loss of condition, and therefore commercial value, to the main farmed species of cattle, pigs and sheep. The presence of disease also blocks our export markets. The disease is highly infectious between animals. It can be transmitted by movements of people and vehicles. Unlike classical swine fever, with which we had to deal in East Anglia last year, it is carried through the air.
	"Firm control measures had to be taken. The Government are well aware of the disruption the temporary controlled area in Great Britain has caused to farming, the food chain and the wider rural community. I pay tribute to the responsible approach that the industry and the public are taking.
	"During the course of this week, the State Veterinary Service, under the Chief Veterinary Officer, will continue its huge task of tracing and controlling the disease. They have been assured of all the resources they need for that task. The Government are calling on the private veterinary profession and other countries' state veterinary services for assistance.
	"Baroness Hayman, the Minister of State, will be meeting industry and veterinary representatives tomorrow with the Chief Veterinary Officer. Among other matters they will discuss whether it is possible, consistent with a rigorous approach to the control of disease, to allow for some tightly- controlled movement of livestock for slaughter. Consideration will also be given to the possible temporary closure of footpaths and rights of way where this is necessary on disease control grounds.
	"We are keeping in the closest touch with the retailers and food producers to ensure that there should be no serious disruption to food supplies. I am grateful to consumers who have, as I have requested, continued their normal pattern of buying.
	"The House will know that the policy of successive governments has been that compensation is paid only for animals which are slaughtered for disease control purposes--in the case of foot and mouth disease, at full market value. Foot and mouth disease presents a relatively clear clinical picture. Incubation periods tend to be short. I therefore hope that movement restrictions necessary for disease control will not have to be too protracted.
	"The Government are determined to eliminate this disease. I, my ministerial team and my department's staff will give this work the highest priority. I welcome the firm support we have received from the industry, from people throughout the country, from our European partners, and from others further afield, in our efforts to do so."
	My Lords, that concludes the Statement.

Baroness Byford: My Lords, we welcome the Statement repeated by the noble Baroness. I thank the Minister for bringing us up to date in this tragic circumstance. When the original Statement was made, as she rightly said, there were only nine cases. Now there are 12. This is an appalling crisis. We express our sympathy to all those directly involved in the foot and mouth outbreak and to those suffering as a result of restrictions being imposed; to hauliers and others, many in the allied trades. We support the stance of the Government in dealing with this crisis. It has been an horrendous blow to the farming industry coming so soon after the swine fever outbreak.
	The most important thing the Government must do is to find out the cause of the outbreak and how it came into this country. That, together with the containment of the outbreak is the number one priority. We support the Government in their efforts. Perhaps I may pose some questions to the Minister.
	First, as the Minister stated, at this stage compensation is being paid only for animals which are slaughtered and not for those which are confined because of restrictions. The Statement refers to protracted movement restrictions. Can the Minister be specific about that because obviously it will have cash flow implications.
	Secondly, some £200 million of agrimoney has not yet been claimed by the Government, much of which was allocated for livestock. Are the Government considering giving cash help to those affected, who cannot move their animals off the farms? Thirdly, I refer to closure of access. It is important that we discourage the public from going on rights of way. Has the closure of access been extended to land owned by the MoD and other departments which might involve public access? I was disturbed earlier today to hear somebody say that they had seen more people on the moors this weekend than earlier times, which is tragic. Fourthly, the Minister referred to the seven-day movement ban. That is presumably due to expire on Friday 2nd March. If the dreadful crisis continues, presumably that also will be extended. Perhaps the Minister could comment on that.
	Fifthly, am I correct in understanding that the ban applies to the whole of the UK and not to the separate devolved parts of the United Kingdom? Can the Minister comment on a rumour in the press that perhaps there will be regional bans and sanctions may be lifted in some regions if the disease ceases to spread?
	The Minister told us that the last three identified outbreaks were linked to Devon. Given that there are substantial animal movements around the country, of which the Minister is well aware, do we need to be more cautious than in the past? Obviously, it is possible that if a greater number of animals are moved, the disease may tragically spread wider than originally estimated.
	Finally, I should like to ask about the logistics to deal with the slaughtered animals. I am aware that a great deal of organisation is required to ensure that the necessary coal and wood is available and so on. Presumably, those arrangements are either being put in hand or are already in hand. Originally, only one area was affected but now it is many. I do not want to take up the time of the House, but I have many other questions to ask.
	Before I sit down, I should again like to express our sympathy, which I know is shared around the House, for all those who find themselves in this dreadful crisis. Sadly, over the past two years we have had debates which reflect the dire situation in farming. This is just one more dreadful blow. We support the Government's stance and look forward to hearing the Minister's response.

Baroness Miller of Chilthorne Domer: My Lords, we on these Benches are appalled that this disease has become a countrywide problem. We feel deeply for farmers and all those who are involved in the rural infrastructure. It is particularly hard to be plunged into something so dire at a time when the industry appears to be emerging from the depths of depression after the BSE crisis. We feel very deeply for those in the west country who last week had the small hope that the problem was contained and learnt that the first case was confirmed on Sunday morning.
	It is right that the Government should act with decisiveness and ruthlessness. As the Minister made clear in the Statement, the Government will continue to slaughter animals. This is not the time for indecision. We are pleased that the Government have been so decisive.
	I should like to put a few questions to the Minister. First, there is a report in today's Evening Standard that modelling is being done based on wind and weather and the statistic to emerge is that some 2,000 farms will be affected. Is the noble Baroness aware of that? Can the Minister say whether MAFF is involved in that modelling? Secondly, obviously some people need to drive from farm to farm, for example those who drive milk tankers to collect milk, postmen and so on. What guidance is being given to those who perhaps are not directly involved in agriculture; for example, postmen?
	At the moment, is there any compensation for those who are directly affected? Obviously, if the ban extends much beyond Friday, and for weeks, it will begin to affect, for example, cattle in the over-30-month scheme; they will fall within it because they will have aged during that time. Will the Government consider compensation in respect of those animals which become unsaleable because they cannot be taken anywhere for slaughter?
	I hope that in the longer term the Government will do all that they can to persuade supermarkets, which have done so much damage over time to the British farming industry, not to redevelop an import culture. I hope that they will regard this as a very short-term issue. I was pleased to see the weekend before this happened posters in Tesco which promoted Somerset farmers. I very much hope that supermarkets will continue to support the British market when this is over and that all of the initiatives which have been taken to encourage people to buy British produce will continue.
	There are other questions, but because there are many here who are deeply involved I shall not put them now.

Baroness Hayman: My Lords, I am grateful for the comments of both noble Baronesses. Both are well aware of the impact of this disease on the industry, the whole of the rural economy and the food chain. In response to the noble Baroness, Lady Byford, epidemiological teams are already looking particularly at the Northumberland farm, where the disease appears to be of longest standing, and, therefore, is probably the index case, to determine the initial route of infection. I ask everybody not to leap to conclusions. There are a number of possible routes of transmission and we must find out exactly how it happened. We must find the cause in parallel with, but not at the expense of, containment of the disease. The House will be aware from the Statement and the change in the numbers of confirmed cases that this is a rapidly developing disease and containment must be the highest priority.
	The noble Baroness, Lady Miller, described how this matter would be received in the west country. The area concerned already has a high incidence of bovine TB and this is an added burden for farmers.
	The noble Baroness, Lady Byford, asked about the continuation of the controlled area status of Great Britain as of Friday midnight when the current controls expire. We are looking at this on a daily basis. We shall take whatever measures are necessary for disease control based on advice from the Chief Veterinary Officer. However, as the Statement makes clear, in relation to domestic produce going into the food chain we shall look very carefully at the possibility, within the parameters of disease control, of the limited licensing of direct slaughter, which is one way to ensure that we do not have the prolonged restrictions about which the noble Baroness asked me. I have talked about prolonged restrictions because some people have asked about the pig welfare disposal scheme in East Anglia. That was a unique scheme to deal with animals on farms where there were severe welfare problems because of overcrowding as a result of prolonged restrictions. We hope that we shall not be in that situation.
	The noble Baroness asked me about agrimonetary compensation. She will not be surprised to learn that the president of the NFU made the same point when he saw me and the Minister this morning. Obviously, we shall take into account what he says. However, the pig sector, for example, will not be helped by agrimonetary compensation because it is a very lightly supported regime. Equally, as both noble Baronesses have pointed out, the impact of this disease goes far wider than simply the farming industry; for example, the haulage industry.
	I was asked about the logistics to undertake the disposal of animals. Yesterday I was at the disease control centre in Chelmsford. To provide coal and railway sleepers and dig the pits is a matter of logistics. That has been done in Northumberland and Chelmsford. There is a central facility at Page Street in London that is looking at providing what is necessary and at taking good practice into needy areas.
	I turn to the point about the Evening Standard article. I have not seen that myself. Certainly, in terms of drawing up exclusion zones around the infected areas where disease has been established, we take into account meteorological information. It is not just a 10 kilometre circle around the farm. Wind and weather conditions are very much taken into account because of the ability for the disease to be wind-borne.
	Any regional lifting of restrictions, either national or export, will need to be done on the basis of disease control. That will only be done, either by ourselves as an exporter or internally, when it is considered safe in terms of disease to do so.
	On the last point about the practical issue of milk tankers that have to visit farms, advice is being put out about disinfectant regimes. Sadly, there is a great deal of knowledge of what needs to be done. But we discussed the issue of making sure that unnecessary visits to farms by utilities or by government departments are not made. One matter we discussed with the NFU this morning was the possibility of sharing the advice that goes out from our helpline and their helpline; for example, making sure that good practice on simple issues, such as leaving a car used for domestic purposes outside rather than inside the farm, is carried through.

Lord Jopling: My Lords, those of us who are farmers, and especially those who were Members of another place during the dreadful epidemic of 1967, remember that situation with a shudder and can only hope that this outbreak does not develop in the same way. The vast majority of people, particularly in the farming world, believe that the slaughter policy is correct and that the Government's prompt action in stopping all livestock movements last week was also correct. Can the Minister say whether any of the pigs at the primary outbreak were fed on pigswill and food residues and remains? Can she further say that if it becomes clear in the next days and weeks that all farmers in the country on all occasions cannot be relied on to boil pigswill according to the regulations, the Government will move in immediately and put a ban on the feeding of that type of material?

Baroness Hayman: My Lords, the noble Lord, Lord Jopling, is correct to say that the farm in question was licensed not to produce but to feed swill to the animals concerned. Perhaps I may answer his question in very general terms. We shall do everything we can to investigate the route of transmission of foot and mouth disease. When we have investigated and found out what that route is, we shall take the necessary measures to ensure that that risk is eliminated.

The Countess of Mar: My Lords, I well remember the 1967 outbreak and seeing the country areas of Worcestershire alive with burning funeral pyres at night and the smoke reaching up to the sky in the daytime. I sincerely hope that that will not happen again. I also hope that my goats will not have to go the same way as many people's cows, sheep and pigs. I know that I would be devastated. I am sure that those farmers are as well.
	On that basis, perhaps I may ask the Minister what emotional support is being given to farmers who are bound to be extremely isolated because of the restrictions. Also, what is to happen with fallen stock? We are at the height of the lambing season and ewes do die in the process of lambing. Will farmers be required to produce a veterinary certificate to prove that their animals have not died from foot and mouth disease? How are they to be disposed of? We normally send our dead animals to kennels. What is to happen there?
	As the abattoirs are closed at the moment, is it possible that some of the Spanish vets who I understand work for the Meat Hygiene Service could be taken into the State Veterinary Service for a temporary period to help out?

Baroness Hayman: My Lords, on the last point, the answer is, yes, we have already been in touch with the Meat Hygiene Service. There are vets there who are available for this work. There are other areas that are shut down and there have been offers of staff; for example, ADAS and the Meat and Livestock Commission. Those staff are already acting. Yesterday, in Chelmsford, there were 67 staff when the complement is normally around seven. Those were people drawn from all over the country and from different areas.
	The disposal of fallen stock is an area that we recognised we would need to deal with. Over the weekend we drew up a general licence to allow the disposal of fallen stock. We had already made an exception for BSE suspects. But the disposal will have to be done under licence. Obviously there are individual routes of disposal, whether to a knacker's yard or to hunt kennels or an abattoir. There is a real problem about the potential spread of disease if someone is on a collection round. One of the issues that we are discussing is the actual terms of that licensing. But we shall be giving advice.
	The noble Countess, Lady Mar, asked about advice for individual farmers. That is a matter about which we are very aware. We discussed, both yesterday and today, ensuring that there is liaison between the disease control centre and the local farming union representative, so that they have up-to-date information to give out. We opened up a helpline last week. There have been thousands of calls to it. The number of that helpline is, for example, on CEEFAX. The website is regularly updated and used.

Lord Stoddart of Swindon: My Lords, I should like to congratulate my noble friend the Minister and, indeed, the Government, on the way they reacted to this crisis. Clearly, there is support for that all around the House. Perhaps I may ask a couple of questions. First, I should like to ask about compensation. That is really important for the agricultural industry, which has received devastating blows, one after another. The farming industry will have to bear many additional costs; for example, the additional feed costs of keeping animals longer than they otherwise would. Secondly, how on earth will some farmers, because there will be no cash flow, pay their bills and how will they pay their labour, let alone themselves? I hope the Minister will give attention to that matter.
	Perhaps I may ask one other question. We are well aware that nearly 1,000 small abattoirs have closed over the past five years as a result of the imposition of the Meat Hygiene Service by the previous government and the European Community. Foot and mouth disease spreads very easily and quickly. Animals have been taken hundreds of miles to be slaughtered, whereas previously they would be slaughtered within 30 miles of the farm. Will the Minister give serious consideration to this problem with a view to re-opening small abattoirs with Government assistance, so that cattle for slaughter are not moved over long distances? That is bad for the cattle and bad for the consumer.

Baroness Hayman: My Lords, we understand the implications of my noble friend's point. As I said earlier, compensation arrangements are there for those whose animals are slaughtered. There are widespread consequences for the industry and the industry will, I am sure, want to argue its case in that respect. We recognise the issue, but there are such widespread ramifications, as was the case with classical swine fever, that we have to look at particular issues, such as the welfare of animals on farms.
	I hear what my noble friend says about small abattoirs, but we have to be careful in this respect. The centre for disease transmission is between live animals at markets intermingling with other live animals. The disease was first detected at an abattoir because of the attentiveness of a vet from the Meat Hygiene Service, who saw the symptoms. There are issues about long-distance travel, but animals travelled long distances to this abattoir because of its specialised nature as a business. It has been going on for many years. While there are many issues to be raised about small abattoirs and their importance in the countryside, I do not think that they can be raised specifically in terms of the spread of disease in this situation.

Lord Crickhowell: My Lords, against the background of the devolved assemblies, perhaps I may press the noble Baroness on the answers that she has given about there being an integrated--I hope totally integrated--approach for the whole of the United Kingdom. She referred to the devolved administrations. She referred to the fact that there was an outbreak in Hereford, close to the Welsh border. I was concerned to see the extraordinary comments of the National Assembly's rural affairs Minister, Carwyn Jones, in Cardiff, who said that it would be possible to export from Wales even though the export ban might be in place in the rest of the United Kingdom. Can the noble Baroness assure me that in these horrible circumstances, where the threat applies equally to every part of the United Kingdom, there will be only one approach and that that will apply to the export ban as to every other aspect of the way the matter is tackled?

Baroness Hayman: My Lords, disease does not respect national barriers, local government or devolution boundaries. The export ban was put in place on a UK basis. We are working with partners. If there were any potential for the regionalisation of a ban in the future, as takes place in some areas of the world with regard to disease control and disease status, such as foot and mouth disease, it would be decided not on politics but on disease. That is all that I can say. I have not seen the comments to which the noble Lord refers.

Lord Mackie of Benshie: My Lords, can the noble Baroness say a little about her troubles in coping with this enormous outbreak? She said that the ministry is looking everywhere for help. The veterinary profession and agriculture have declined enormously since the previous outbreak. Is there any possibility of all the vets who have gone to the profitable care of small animals coming in to help in this case? It appears to be the only source that the Government have.

Baroness Hayman: My Lords, the Chief Veterinary Officer has made an appeal to private practice to see whether any vets in private practice--small animal practice or farm animal practice--would be willing to work temporarily for the State Veterinary Service. There are in existence reciprocal arrangements with other countries. We are putting those into place. I understand that some vets are coming in from New Zealand today. During the outbreak of classical swine fever we had vets from Ireland, America, Australia and Holland. We have had offers from those countries. We will be accepting those offers. People are often very interested in gaining experience. We are certainly accepting offers of veterinary assistance.

The Lord Bishop of Hereford: My Lords, from these Benches I thank the Minister for repeating the Statement and I express our deep sympathy to the farming community. I pay tribute to the Government and to the veterinary profession for the speed with which they have dealt with this dreadful outbreak.
	I wish to press two points. The first concerns compensation. It is well known that the farming community is at a very low ebb indeed. For the mostly small farmers in the beef, sheep and pig producing areas who have simply no resources to fall back on, the question of compensation is desperate and urgent. Does the Minister recognise that even though agri-monetary compensation is not available right across these sectors, that is not a reason for not paying it to those who are eligible to receive it? The Government could find some means of compensating those who are not eligible for that source of help. Is it possible to consider making, for example, an exceptional and large block grant to the Royal Agricultural Benevolent Institution, which is well practised in these matters--sadly, it has become extremely well practised in recent years--to allow it to care pastorally for farming families, which are desperate in terms of cash flow and do not have money to buy food? Is that one channel through which emergency help could be given?
	Secondly, will the noble Baroness look again at the issue of abattoirs? Farmers travel the length and breadth of the country. Some like to do it and are used to buying animals from the other end of the kingdom. However, at the same time any travel that can be avoided should be avoided. The Government are introducing new regulations and a new charging regime for abattoirs. There are small abattoirs that have closed in recent years. They could reopen and be viable. Will the noble Baroness look again at that possibility? I agree entirely with what the noble Lord, Lord Stoddart of Swindon, said on that point.

Baroness Hayman: My Lords, I am aware of the concern about small abattoirs. We have put £8.7 million into the charging structure, recognising the importance of small abattoirs in the rural economy. We shall continue to look at that issue and give support where we can. In terms of disease control and disease spread, the movement of live animals from market to market, being parcelled up and sold on, is a more potent factor in the spread of disease.
	I appreciate what the right reverend Prelate said about the case for compensation. As I said earlier, it is being put very clearly. I have stated the position as it is at the moment. We are in continuous dialogue with those representing the industry. We have a meeting with all sectors of the industry tomorrow morning. These issues are kept under the closest review.

Lord Rotherwick: My Lords, perhaps I may ask the Minister about wild deer. I am a farmer and also manage park deer and wild deer. Is the noble Baroness aware that there are more freely roaming deer around than ever before--certainly more than was the case 25 years ago? They roam not just through forest and woodland. They are the muntjac that come into our gardens. Has the Minister considered the implications of our wild deer being infected by foot and mouth? It takes professional stalkers approximately a year to kill a significant number of deer. Can the Government make sure that the general public are made aware that the open countryside and forests are just as vulnerable to foot and mouth as the farmyards?

Baroness Hayman: My Lords, it is absolutely correct to state that deer are a susceptible species. The export ban and controls apply to farmed deer as well as to cattle, sheep and pigs. The issues of wild deer and wild boar are being considered and have been included in the thinking of the Chief Veterinary Officer as regards any necessary action to be taken within infected areas.

Baroness Masham of Ilton: My Lords, I must declare an interest as the owner of a flock of pedigree Texel sheep which are presently lambing. Can birds such as crows and starlings spread the disease? Furthermore, what is the position as regards animals such as hedgehogs and foxes? What can be done about this?

Baroness Hayman: My Lords, I may need to make this up to an extent. As a matter of extrapolation from the fact that human beings and other non-susceptible species such as horses can carry the virus when travelling, then I must assume that, equally, other animals and birds could do so. However, a sentient vector is not needed because the wind can carry the virus.

Lord Elliott of Morpeth: My Lords, while I wholly agree with the noble Baroness that one should not be in too much of a hurry to reach a decision on where this awful business began, will she accept that I have often driven past the farm at Heddon-on-the-Wall and that two points have struck me about it? First, it is an extremely untidy farm. Secondly, if the wind is in the wrong direction, a strong smell comes from it.
	The noble Baroness will know that the pig in the first abattoir came from that farm. Is she also aware that many complaints have been lodged about the conditions suffered by animals on that farm? Neighbours have complained over and over again. An animal welfare organisation took up the case as recently as last December. Local veterinarians have constantly appealed for action to be taken as regards this farm. However, officials from the Ministry of Agriculture, Fisheries and Food have turned down any requests to take action beyond telling the brothers who farm there to "get their act together".
	Finally, does the Minister agree that it is appalling, having seen photographs in the local press of the conditions on that farm, to see animals being kept in such a way? Surely stronger regulation should be put in place to curb such fearful squalor, irrespective of whether the animals are the cause of this outbreak? We need better regulation to keep under control such appalling practices.

Baroness Hayman: My Lords, it is interesting to hear the call for more regulation.
	I understand the points made by the noble Lord. However, I hope that the House will understand if I do not comment in any way on the circumstances of an individual farmer or an individual farm. As I said earlier, the necessary investigations are taking place. If the House will allow me, I should like to leave it at that.

Capital Allowances Bill

Lord McIntosh of Haringey: My Lords, I beg to move that this Bill be now read a second time. The Bill rewrites, with minor changes, legislation about capital allowances so that it is clearer and easier to understand. In one sense, therefore, this is a very narrow Bill. But the Bill also marks a major milestone on the way to making tax legislation more user friendly. It is the first Bill from the Inland Revenue's Tax Law Rewrite Project to come before the House. I hope that it will help if I put the Bill in its context before turning to its substance.
	The Tax Law Rewrite Project was set up in 1996, following extensive consultation, to rewrite all or most of the United Kingdom's legislation for direct taxes--over 6,000 pages of legislation enacted over the past 200 years. The then Chancellor of the Exchequer, Mr Kenneth Clarke, said in his November 1996 Budget Statement:
	"The project will bring the benefits of clarity and certainty to businesses and ordinary taxpayers. It has been widely welcomed and deserves the continuing support it has enjoyed in all parts of the House".--[Official Report, Commons, 26/11/96; col. 170.]
	The main features of the project can be summarised briefly. It puts the legislation into a clearer and more logical form for readers. This includes shorter sentences, modern language, clearer signposts to related provisions, more consistent definitions and, where helpful, greater use of reader aids such as formulae and tables. But restructuring the legislation is probably the biggest single benefit of the rewrite process.
	What the rewrite process does not include is changes to tax policies. The project is not, and never was, about that. Proposals for changing policy will continue to be dealt with in the usual way in finance or other Bills. But it was accepted from the outset of the project that some minor changes might be proposed in order to improve the legislation--for example, by legislating extra-statutory concessions, filling gaps in the statute or correcting anomalies--subject always to such changes being flagged up very clearly.
	The whole process is based on full consultation at every stage. The project's work is overseen by a steering committee chaired by the noble and learned Lord, Lord Howe of Aberavon, who I am delighted to see will be taking part in this debate, with members drawn from both Houses of Parliament, the legal and tax professions, business and consumer interests. There is also a standing consultative committee drawn from the main representative bodies for tax, business and consumer affairs.
	The project also publishes draft legislation, with commentaries, for wider consultation. I am glad to have the opportunity to acknowledge the contribution made by the committees and all the others who comment on draft legislation.
	I shall now turn to the substance of the Bill. Broadly speaking, capital allowances are tax allowances given to businesses which incur capital expenditure on assets they use in their business. They take the place of the depreciation charged in commercial accounts which is not allowed as a deduction for tax purposes. They cost an estimated £18.8 billion in terms of tax forgone for the year 2000-01.
	As I have already indicated, the Bill is not about the substance of these allowances. The Bill rewrites, with minor changes only, the existing legislation about capital allowances. It brings together some 300 pages of legislation, much of it dating back to 1945, which is currently scattered across various Acts. That alone would be useful to users, but the Bill does much more than traditional tax consolidation Bills. It puts the legislation in a more logical and consistent order and makes it easier to understand.
	Achieving this improvement was very much an iterative process. The consultation process I mentioned in general terms involved, for this Bill, the publication between October 1998 and February 2000 of four separate exposure drafts. In August 2000 the project then published a draft Bill for a final round of comments. Comments on all those drafts greatly improved the Bill.
	Consultation also helped with the Explanatory Notes which accompany the Bill. They explain why the legislation has been written in the way it has. They also include, in Annex 1, extremely detailed explanations of each and every one of the 66 minor changes made by the Bill. These minor changes have been very properly the subject of particular parliamentary attention.
	It was recognised from the outset that a new procedure would be needed for Parliament to handle rewrite Bills. A report, known as the Howe Report, made proposals for that in 1996. Its recommendations were largely adopted and developed by the Procedure Committee of the House of Commons in 1997 and then by this House in November 2000. Hence the Bill comes to us after scrutiny by a joint committee of the two Houses. This brought to bear on the Bill the expertise of Members of your Lordships' House.
	The committee's report and minutes of evidence speak for themselves, but I should like briefly to comment on two points. First, the joint committee considered explicitly the question of whether changes in the Bill were both minor and appropriate. In the report the conclusion was that the Bill,
	"makes changes to the existing law that are of such minor significance that they need not be referred to the attention of Parliament".
	Secondly, the Joint Committee was both able to make amendments to the Bill and considered doing so. The fact that it did not do so is, I suggest, a measure of the extensive consultation which preceded its introduction.
	Against that background, the Commons dispensed with further detailed consideration of the Bill. There is, similarly, I suggest, no need for your Lordships to examine the Bill further after today. One of the benefits of the joint committee process is that the Bill has already been examined by noble and learned Lords and by noble Lords. That is the background to the Motion on the Order Paper in my name to negative the Committee stage of the Bill.
	My final comment on the progress of the Bill concerns the amount of independent scrutiny that it has received. Every professional and representative body, business or individual had the opportunity to comment on the draft legislation. The successive exposure drafts and draft Bill were published with just that in mind. The Bill has been warmly welcomed by them. For example, the Law Society commented in a memorandum to the Joint Committee that,
	"we welcome the publication of the Capital Allowances Bill. We believe that it does represent a significant improvement upon the existing legislation".
	The tax faculty of the Institute of Chartered Accountants in England and Wales commented last year that,
	"the quality of the draft reflects the enormous amount of work undertaken by the Revenue in consultation with organisations such as ours".
	To sum up, the Bill is a significant milestone in the work of the project to make tax legislation clearer and easier to understand. It shows that it can be done. It will help businesses and other taxpayers and those who advise them. It has been welcomed by them. It has so far enjoyed the support from all parties which Mr Kenneth Clarke in 1996 quite rightly said the project deserves. I commend the Bill to the House.
	Moved, That the Bill be now read a second time.--(Lord McIntosh of Haringey.)

Lord Newby: My Lords, we on these Benches support the Bill, as we do the tax law re-write project. I begin by putting on record the credit that we believe is due to the noble and learned Lord, Lord Howe, and his steering committee, which has done a tremendous amount of work, and to other noble Lords and Members of the other place who have worked very hard on the Joint Committee.
	The principles under which the work has been carried out are clearly welcome. It obviously makes sense that tax law should have a logical structure and be written in a way that is more easily understood. However, the time that has been necessarily taken to get to this stage underlines two matters which always go with tax law. First, by its very nature, tax law becomes complicated. If one looks at some of the provisions in this Bill and considers why and when they were introduced, one realises that, over time, complexities arise. The fact that there were special provisions for dredgers, for example, was no doubt hugely important in the 1950s, when I think they were introduced, but the reasons are certainly lost in the mists of time. That kind of accretion of tax legislation inevitably occurs and, over a period, makes the legislation more complex. The more that legislation can be put into a framework which enables change to be accommodated without making it unnecessarily complex the better.
	My second point, which flows from that, is that any hope that at the end of the day one would end up with a complete layman's guide--or, as it were, a "dummy's" guide--to capital allowances is a forlorn hope. We may end up with something which is more easily understood but it will not be something which will be easily understood by the layman. It is difficult for us as near laymen to understand much of the Bill without working very hard on it. However, we should not be too worried about that; that is part of its nature. The key issue is that the legislation is as simple as it can be; it is in the nature of tax legislation that it will end up being relatively complex.
	Before moving on to make a point about procedure, perhaps I may ask the Minister one or two questions. The tax law re-write project was started in 1996. I believe that at that stage it was hoped that the whole process might be completed within a relatively limited period of time; I think five years was mentioned. We now have, as it were, Chapter I of this great re-write, which has taken five years. What is the programme of activity for going forward? Which chunk of tax legislation is the noble and learned Lord, Lord Howe, now getting his teeth into? What is likely to be the timetable before we are considering the next Bill in the project?
	My more substantial point relates to the way in which the Bill has been dealt with by your Lordships' House. Here we are, in prime time in the middle of a working week, looking at an essentially second order Bill in terms of taxation, which has been through a Joint Committee on which Members of your Lordships' House sat. I contrast this procedure with the situation in which we find ourselves every year with the Finance Bill. The noble Lord, Lord Saatchi, and I have made these points many times. No doubt we will need to make them many more times before there is any change.
	The Finance Bill comes to this House completely undigested, completely unlooked at by any noble Lord. It arrives on a mid-summer morning--usually the day on which the House is rising for the Summer Recess or, if we are lucky, the previous day--and it is given a couple of hours debate in your Lordships' House; and then everyone breathes a sigh of relief and we go off for our summer holidays. The noble Lord, Lord Saatchi, has attempted to address this problem with the Bill that he introduced last week--a Bill which we on these Benches are happy to support. This Bill and the way we are dealing with it underlines the nonsense of the current situation. We can spend a long period in prime time discussing this Bill, but when it comes to the main business we are almost completely excluded. Certainly in terms of looking at the detail of finance Bills we are completely excluded from that consideration.
	I hope that, after the election, when the joint committee looks at the way in which this House should operate after the next stage of reforms, one of the items on the agenda of that joint committee will be the question of how we deal with finance Bills in a sensible manner. The expertise which the Government and the other place are very happy to bring to bear in considering this Bill is just as much available for every finance Bill. When we come to look at the way in which this House is run--and, indeed, when the other place looks at the way in which the reformed Second Chamber will work after the next stage of reform--it would be a logical step to get to grips with the procedure and for us to deal with finance Bills with the degree of thoroughness that has been possible with this Bill.
	With those caveats, I repeat that we on these Benches give the Bill our warm support.

Lord Howe of Aberavon: My Lords, it goes without saying that I am most grateful to both previous speakers for their tributes to myself in this connection. For me, this is the end of a long road that started when I gave an address to the Addington Society in 1977 calling for a wide-ranging upheaval and reform of our tax-registration machinery. I suppose a quarter of a century is not too bad by British constitutional standards.
	I must confess that I was not able to do much about it while I was the Chancellor of the Exchequer. However, I make one plea in mitigation; that is, that although I introduced a number of benign schemes such as the business expansion scheme and the business start-up scheme--which turned out to be hideously complex and, in the end, fruitless--I found the opportunity to abolish development land tax, the national insurance surcharge, capital transfer tax and the reduced rate band. In those days we only had two bands of direct income tax, and I got rid of one of them. Since then my successors have been concerned to reverse the process. We now have immensely more complication than we had then. That only goes to show how difficult is the task.
	I should like to take this opportunity to thank all those who have taken part in the campaign to get this subject onto the national agenda--in the professions, in the Institute of Fiscal Studies, and fellow members of the committee who worked with me. Above all, perhaps I may pay tribute to the work done by the Inland Revenue itself. There was some criticism at an early stage about placing this work in the hands of those whom some of us may regard as "enemies" in this field. But they are just as interested in securing simplification as anyone else. As an equivalent to the Law Commission, it was wise and essential to put people of their experience in the workshop of this project--cross-fertilised, if they do not mind my saying so, by the introduction of people from the private sector and above all strengthened by the secondment specially for this purpose of counsel from the Office of Parliamentary Counsel, who have dedicated themselves to innovative legislative techniques of enormous value in this field. I shall return to that topic in a moment.
	I am grateful to the Minister for his very clear exposition of the whole process that has led to the production of the Bill and of the role played by the two committees, the Consultative Committee and the Steering Committee. I am grateful to the Minister also for making it plain that this is a "tax law rewrite" project, not a "tax policy simplification" project. As he says, that in itself is of enormous value. The chairman of the Special Committee of Tax Law Consultative Bodies, Mr Adam Broke, who has played a leading part in this work and who gave evidence to the Joint Select Committee, explained in his own words just how important that was when he said:
	"I need to be able to find the legislation that is applicable, understand how it operates and advise my clients accordingly. For me, the Capital Allowances Bill represents a revolution in accessibility. It has a logical structure and for the first time in my experience it has actually been designed to help the user".
	His words echo those of the Minister. That is what we have tried to do.
	Many people are understandably dismayed that we have not at the same time been tackling the simplification of tax policy. I shared the ambition for that objective. My right honourable friend in the other place, Mr John Redwood, expressed his dismay on a topic of that kind with remarkable vigour but with understandable anxiety. As I say, I wanted that to be achieved as well as the tax law rewrite. But people who have been concerned with this process recognise that we cannot do both at the same time. There are those who have said that we should postpone the rewrite until we can simplify the policy as well, or that we should do both at the same time.
	It must be recognised that that would be impossible. If we were to try to postpone the rewrite until we had simplified the policy, we should be throwing out the horse before we had even found the cart, which would be a pretty perverse way of setting about it. One of the products of the rewrite process has been the identification--as John Redwood said in his speech--of excrescences and complications that can begin to be tackled by politicians later on. There is a huge agenda to be tackled.
	As regards procedure, the Joint Select Committee recommended a change in the committee's name from the Joint Committee on Tax Simplification to the Joint Committee on Tax Law Rewrite Bills. I commend that proposition to the House. "Tax law simplification" raises expectations unduly high; "tax law rewrite" is the accurate description of the project.
	Two criticisms were voiced in another place about the procedure adopted so far. The first was that there had been no opportunity for the committee to take independent advice in examining the Bill. The truth is that every conceivable independent voice in the country has been mobilised to look at the matter in one way or another. That has been the purpose of our consultative process. It is important that, as we have done already, when the Bill arrives before Parliament it should once again by publicised, so that the Toms, Dicks and Harry's in the hedgerows and by-ways of this country who have failed to notice it until that point themselves come along with independent experts if they wish to do so. But I do not think that we can do much more to get wider-ranging scrutiny than we have done.
	Another slightly curious criticism was voiced in another place by another old friend of mine--if that is not an unparliamentary way of putting it----Mr Eric Forth. He suggested rather curiously that this work was being done by what he called the "usual gang", the "usual suspects"--the people who were always involved in looking at tax legislation and knew all about it. I do not think that that is necessarily a bad thing, if their purpose is admitted by everyone to be benign and if the output is admitted by everyone to be of reasonably high value.
	I should like to pay tribute, for example, to the contribution made to this whole process by the noble and learned Lord, Lord Brightman. He was concerned with shaping the ideas that formed the Joint Select Committee, drawing on his formidable experience having chaired many consolidation Bill committees. That precedent is one of the inputs that he has made. The noble Lord, Lord Goodhart, who is in his place, looking as benign and wise as ever, made his own contribution; this is also a field in which he has been active.
	To be frank, perhaps the only one of the "gang of three" who served on the Joint Select Committee and who perhaps ought not to have been there was myself. If one goes back to the original precedent on which we drew--the handling of the Customs and Excise Act 1952, which was produced in this way by a Joint Select Committee--the oversight of that project was undertaken by the noble Lord, Lord Kennet, with a special committee designed for that purpose. The noble Lord produced the report which gave rise to the Bill that came before both Houses, but he did not sit on the Joint Select Committee: perhaps rightly so, because he was in effect one of the progenitors of the Bill, as I am to some extent--if not a progenitor, at least a promoter with a certain interest in its survival.
	I confess that I was surprised to be invited to serve on the committee. I regarded myself rather more as a witness and a cheerer from the stands than a member of it. Who knows who may replace me when the time comes? That person may well not be a Member of this House. I offer that thought, not because I resented being on the committee, but because I can see that there is a certain validity in that analysis.
	The question of our future work programme was raised by the noble Lord, Lord Newby. I agree with the noble Lord that it is disappointing that the task has proved as enormous as it has. We have produced 300-plus pages against an existing stock of 6,000 pages. So, 5 per cent in five years is not too good. Our immediate future programme involves the production of the income tax legislation--the heart of this problem. That was intended to produce a complete income tax Bill of over 1,000 pages long. Because of the scale of that task, the rewrite project team decided that it should be done in two stages. A first income tax Bill is planned for November 2002 covering employment income and related subjects such as social security and pensions income. A second income tax Bill is planned for November 2003. That will cover such topics as trading income, property income and savings and investment income. Those will be heartland topics.
	It will be quite difficult to keep up with that timetable. So it will be important for those who, as it were, service our work appreciate the need to keep us fully equipped with manpower as well as goodwill. The scale of the task is formidable. It involves, in the project team, about 42 people at the coal-face plus the seconded people from the Office of Parliamentary Counsel. Colleagues who have served in government will know that there is no more hard- pressed corner of the governmental machine than the Office of Parliamentary Counsel. Committee after committee has drawn attention to the scale of their work. The noble Lord, Lord Renton, produced work on it in the 1970s; the late Lord Rippon produced work on it within the past few years. Every time I have been in government I have urged addition to the resources of the OPC.
	You cannot train parliamentary draftsmen overnight, least of all parliamentary draftsmen who are learning the rewrite technique. It is of the utmost importance to recognise that no single individual is responsible in the machinery of government for this office--indeed, it hovers between the Prime Minister, the Lord Chancellor and even the Law Officers' Department. That is a dangerous situation. I hope that the Minister will take this message: if this task is to be carried on even at its present pace, let alone a faster pace, we need to have enlarged resources available to support the magnificent work that has been carried out by those people concerned.
	I should like to mention the point raised by the noble Lord, Lord Newby, and one that is demonstrated by the very powerful--though not looming--presence of my noble friend Lord Saatchi on the Opposition Front Bench. He, too, has taken an interest in the topic. There is no doubt that two factors should be acknowledged when studying the production of legislation generally, especially fiscal legislation. First, the Standing Committee procedure on a Finance Bill, like most other Standing Committee procedures in the other place, has become less and less effective, if it ever was effective, in the proper Committee stage study of complex legislation. I shall not go into that in detail now because it has been well studied in a book written by a Member of the other place, Mr Andrew Tyrie. Mr Ferdinand Mount has also written about it. Moreover, the Norton commission, under my noble friend Lord Norton, reached the same conclusion.
	The way in which the Financial Services Act was handled in this House--again, I look with admiration at my noble friend Lord Saatchi--demonstrates the extent to which this House does most of the hard work in enhancing legislation. It is often said that what we are doing is tidying up the bits and pieces that have been identified with such clarity in the other place. That is nonsense. There is everything to be said for finding a way of engaging this House in the process. That is why I am delighted that we have taken this step so far. My noble friend Lord Saatchi has proposals before the House that seek to approach the matter in a different way. I am not sure that his is necessarily the best way, but I look with benign interest upon his intelligent activity on this front.
	Although we have what we have by way of this machinery, I express the hope that we can be sure that it will continue to work well as we enhance and strengthen it. It is a very valuable method of studying such legislation. I am delighted that governments of both parties have recognised that value. There remains the question of whether we can extend this technique, not just, as the noble Lord, Lord Newby, observed, to the study of routine finance Bills but also to the wider question of tax policy simplification. I addressed that subject at length last autumn in a speech that I gave to the Institute of Chartered Accountants, the Hardman Memorial Lecture. I believe that we can evolve that technique in order to begin studying the question of tax policy simplification, as well as tax law rewriting.
	I turn to my final point, which is not unimportant. Quite aside from the complexity of tax legislation, the second most worrying aspect about it is its overwhelming volume--up from 2,000 pages in 1970 to 6,000 in the year 2000. Indeed, 600 pages were added last year alone. We must do something to stop this roaring torrent of fiscal innovation. I made that point during last week's debate on the report of my noble friend Lord Norton on the strengthening of Parliament. I put forward the one proposal that I believe is worthy of study; namely, a reform of the Provisional Collection of Taxes Act, so that the automatic guillotine that attaches to the rate structure and the core financial elements with which the Commons are rightly concerned--the automatic guillotine applies only to those provisions; it does not apply to everything that Chancellors of the Exchequer of whatever kind or complexity wish to hang on it--can be separated and thereby provide a different track, like this one, for consideration of tax law changes and tax policy simplification. Above all, we must stop the automatic juggernaut created by Lloyd George (no doubt per incuriam, as many other things that he did) in the original Provisional Collection of Taxes Act 1913.
	I hope that I shall not trespass too long on the patience of the House if I make one additional point. I welcome very much what has been said by other noble Lords today. I speak for all those concerned with the project when I express our gratitude for the understanding support that has been given to what we are trying to achieve.

Lord Simon of Glaisdale: My Lords, it is a singular privilege to follow the noble and learned Lord, Lord Howe of Aberavon, partly because of the authority and fertility of the speech that we have just heard, but also because he is the main, motive force behind the reforms of which this is the first instalment. The Minister explained the Bill and its background with his usual exemplary clarity. It has been received with acclamation on all sides of your Lordships' House. Therefore, I desire to make only one or two peripheral comments.
	My first point is on the question of draftsmen. There was a severe setback in 1997 to the proceedings of the committee charged with the rewrite. That was not surprising because any new government tend to put great pressure on the draftsmen. On this occasion, the process of rewrite was undoubtedly set back by the withdrawal of draftsmen. I hope that we can be assured that that will not occur after the next election. I do not know whether I ought to ask that question of the Minister, the noble Lord, Lord Saatchi, or whether the noble Lord, Lord Newby, should also be included. It is most important that the expert draftsmen on these matters should be kept in continual touch and that they should be continually available.
	The second matter is the extent of the amendments that can be made in the rewrite. As I understand it, the committee can now make minor corrections and alterations, providing that it is thought that they are not sufficiently important to be drawn to the attention of Parliament. But one can go a little further on the analogy of what the Joint Committee on Consolidation Bills does. The noble and learned Lord, Lord Howe of Aberavon, referred to that, as has my noble and learned friend Lord Brightman.
	Up until 1949, the consolidation was limited to re-enactment. However, that was importantly extended in that year so that a number of minor alterations could be made to eliminate obscurities, contradictions, and so on. But in 1965 we went much further. The Law Commission, set up under an Act of that year, was able to make recommendations for quite substantial changes designed to improve legislation. I should like to see the committee charged with this rewrite given those more extensive powers.
	The third matter has already been mentioned by the noble Lord, Lord Newby, and by the noble and learned Lord, Lord Howe. I refer to the power of your Lordships' House and to its responsibility to improve the fiscal code. That was recently adverted to by the noble Lord, Lord Desai. The noble Lord, Lord Newby, gave it further encouragement and the noble Lord, Lord Saatchi, has a Bill which is awaiting Second Reading which would carry that matter much further. I hope that it will receive encouragement throughout the House.
	The other place must deal with supply, as the withdrawal of supply is one of the two means of bringing down a government. The representatives of the people--the elected representatives as against the elite representatives of your Lordships' House--must propose on democratic principles the burdens that should be borne. But apart from supply in that wider sense, there is every reason why your Lordships, with their expertise and great experience, should not contribute, particularly as regards tax management.
	That leaves entirely aside Customs and Excise. The deplorable verbosity and obscurity that now commands the attention of your Lordships' House would undoubtedly not have come to that pass had your Lordships been more closely identified with the process of tax management. When we discuss the Bill of the noble Lord, Lord Saatchi, we can discuss how that position came about. It came about by errors on both sides between 1909 and 1913. But that is long past. We can put the matter right now. So far, so well. But for the moment all we can do is to acclaim the present Bill.

Lord Northbrook: My Lords, the Capital Allowances Bill is the first piece of legislation to be introduced by the tax rewrite project which was set up by the previous Conservative administration in December 1996. I congratulate the steering committee on its work and my noble and learned friend Lord Howe of Aberavon who has a job for life if he so wishes.
	I welcome the Bill which standardises existing legislation for capital allowances on plant and machinery, industrial and agricultural buildings, mineral extraction, research and development know-how, patent allowances, dredging, assured tenancies and, finally, contributions. I note that the Joint Committee of both Houses set up to examine the Bill instead of the normal Committee stages has made no amendments to it.
	However, as the shadow Paymaster General said in another place recently, unless future Finance Bills are drafted in the rewritten style, we shall forever go backwards. It will be a case of two steps back and one step forward. For instance, while this Bill to its credit runs to 334 pages, last year's Finance Bill ran to 558 pages. As today's editorial in the Financial Times states:
	"The Chancellor might also think about simplifying taxes: his incessant tinkering bemuses experts and annoys businessmen".
	There are now five income tax bands, 15 rates of capital gains tax, 21 rates of company car tax and hundreds of exemptions from corporation tax.
	One might think that the accountancy profession would be more than happy with this state of affairs, but even it is critical. One of its executives, Frank Askew, said last April of the Finance Bill 2000:
	"This is out of all proportion to anything we have ever seen before; the volume of tax law has doubled since the 1980s. I do not know how ordinary people have a hope of understanding their tax affairs. Even accountants are struggling".
	Last year the Institute of Chartered Accountants in England and Wales launched a campaign for simpler taxation, arguing that the tax system was getting out of control and had become detached from the principles of good revenue raising.
	The other problem is that it is becoming increasingly difficult to scrutinise the Finance Bill in Parliament. As my noble friend Lord Norton stated--the noble Lord, Lord Newby, made an interesting speech on the same theme today--in the Financial Times of 10th April last:
	"This is increasingly recognised as a very serious issue. The longer it is the greater problem it is for Parliament".
	I believe that the Bill of my noble friend Lord Saatchi to amend the 1911 Parliament Act will be pertinent in that regard. My noble and learned friend Lord Howe stated that the Finance Act 2000 was almost twice as long as the Capital Allowances Bill. It is like repainting Brighton Pier when its owners are trying to extend it to the French coast.
	I welcome the further rewrite projects still in exposure draft form but, like my noble and learned friend Lord Howe of Aberavon, I should like the process extended to other taxes such as capital gains tax. Many years ago--before I knew much about tax--the capital gains tax legislation was, I understand, quite simple. If one sold an asset, one deducted from the proceeds the cost and certain allowable additional expenditure. One had an annual allowance and the resulting profit was subject to one rate of capital gains tax. Then the indexation concept was introduced which made the position a little more complicated. Then this Government introduced an additional twist through the concept of taper relief and divided assets into business and non-business categories. To add to the complication, one was given a free year off tax in certain circumstances.
	Capital gains tax has become increasingly complicated. I believe that it would be well worth the project team extending its endeavours to this area, perhaps in the more distant future. I ask the Minister to use his best endeavours to see whether the Tax Law Rewrite Project can extend its focus on this tax as soon as possible to save the shareholding public much time in working out their capital gains tax position. In summary, I fully support the Bill and wish the project team well in future endeavours.

Lord Saatchi: My Lords, perhaps I may express my delight in hearing the Government's strong support for the Bill. It is one of the rare occasions in your Lordships' House when all the parties are in agreement. I congratulate the Government on maintaining what is surely one of the most impressive aspects of the Bill: its cross-part provenance; and on what the Minister described as the admirable level of consultation with the industry and affected parties which preceded its arrival in this House.
	I should like also to congratulate the draftsmen from the Revenue and the tax law rewrite group on the Explanatory Notes. Unusually, they are in two volumes. The only criticism I have heard is that perhaps they are too good. The legal status of the law compared with the legal status of the notes on the law is perhaps a moot point. That is a matter on which noble and learned Lords like the noble and learned Lord, Lord Simon of Glaisdale, may advise the House. I am told that the Institute of Chartered Accountants of Scotland is not worried about this point. It has indicated that the Inland Revenue publishes many booklets and publications of guidance which are outside the law and do not cause any mishap. I am sure all will be well.
	I commend the two volumes of notes. They give to laymen like the noble Lord, Lord Newby, and myself an excellent history of capital allowances. They explain their purpose and structure, who benefits from them and what is their current intent. As the Minister said, the document identifies the 66 cases of change and provides helpful notes on each. No one could have asked for a more thorough explanation of any Bill. Therefore, the Bill now before your Lordships' House is in impeccable condition.
	I echo the sentiments of the tax faculty of the Institute of Chartered Accountants, which described the Bill as an impressive achievement and congratulated everyone involved. Our Front Bench agrees, welcomes the Bill and supports the Minister's plan to negative its Committee stage.
	The need for a tax rewrite project in capital allowances was first flagged up in an article in the Financial Times on 11th August 1986. The report drew attention to the capital allowances provisions of the Finance Act 1986 and to the vitriolic comments from accountants and solicitors, who were irritated by the Act's length and some of its provisions. I agree with the noble Lord, Lord Newby, that a laymen's guide to such matters is almost an impossibility. I give an example from the 1986 Act of the incomprehensible drafting to which many commentators objected at the time. It gives a flavour of the complexity of the system which the Bill seeks to rectify. The 1986 Act states:
	"If, in a case where sub-paragraph (1) of paragraph 10 above applies, neither sub-paragraph (1) nor sub-paragraph (2) above has effect in relation to the expenditure referred to in sub-paragraph (1)(a) of that paragraph, then for the chargeable period related to the disposal or cessation referred to in sub-paragraph (1)(b) of that paragraph, any allowance in respect of that expenditure shall be a balancing allowance".
	I am sure noble Lords take my point.
	Perhaps I may spend a further moment looking at the origins of the tax rewrite project. I say with pride that it was initiated by the previous Conservative government. The first report was introduced in 1996 by my right honourable friend Kenneth Clarke, then Chancellor of the Exchequer. I hope that the Minister and your Lordships will agree that the decision to commence the rewrite was a tribute to the deregulatory instincts of the then Chancellor and his Ministers. Their aim was to achieve a more logical structure with rewritten tax legislation, involving shorter sentences, briefer, more lucid definitions and more modern language.
	The scale of the ambition of the project was summed up brilliantly by the then Chancellor in his Budget speech. He referred to it as a project that was,
	"as ambitious as translating the whole of 'War and Peace' into lucid Swahili. In fact, it is more ambitious ...'War and Peace' is only 1,500 pages long. Inland Revenue tax law is 6,000 pages long and was not written by a Tolstoy".--[Official Report, Commons, 26/11/96; col. 170.]
	That was a good description of the scale of the project.
	I come now to the man who is the undoubted hero of the entire project. As the noble and learned Lord, Lord Simon of Glaisdale, said, he is its main motive force. As other noble Lords have done, I refer to the noble and learned Lord, Lord Howe of Aberavon, to whom the Chancellor entrusted the project. It is interesting to note that the noble and learned Lord, Lord Howe, spoke about the need for tax simplification in his maiden speech in another place in 1964. I hope that he does not mind my reminding him of that happy day. In response to the proposal for some new means-tested benefit, the noble and learned Lord said that it must be one that is simple. So my noble and learned friend has been consistent in his devotion to this cause. His personal aim was that the language of all existing tax law should be simplified, that the benefit would substantially outweigh the costs and that a rewrite of most of the existing code could be accomplished in a reasonable period.
	The noble and learned Lord and his team resolved to use a variety of techniques, all of which have been incorporated in the Bill: first, that there would be a new, more logical structure; secondly, that there would be shorter sentences and better use of definitions; thirdly, modern language would be used as long as it was possible to do so without changing the law or making its effects less certain; fourthly, that there would be better signposts so that similar rules would be grouped together to make them easier to find; and, finally, a new format and layout would be adopted to make the legislation easier to read.
	It is worth remembering that my noble and learned friend Lord Howe had initially become president of the tax law review committee set up by the Institute for Fiscal Studies in autumn 1994. Its purpose was, independently and objectively, to ask fundamental questions about whether the tax system was working as intended. The committee concluded that it was not. Miraculously, just as his committee published its final report, the Treasury arrived at a similar conclusion about the need for reform and my noble and learned friend Lord Howe was duly appointed chairman of the rewrite committee.
	Initially, he confronted powerful forces of inertia, as I am sure noble Lords can imagine, from pre-existing institutions and bodies, and from time-hallowed processes, all of them stacked against change of any kind. Quite how my noble and learned friend overcame that inertia is a mystery to me; but somehow he did.
	We should remember that the problems he began to tackle are not new. In 1853, Gladstone complained in another place that,
	"the nature of property in this country, and its very complicated forms, render it almost impossible to deal with the income tax in a very simple manner".
	It has taken 150 years but I hope that this Bill begins to prove that Mr Gladstone may have been wrong.
	In his remarks, my noble and learned friend Lord Howe drew a distinction between two meanings of simplification. The Bill seeks to address one: to rewrite the law in a way that makes it easier to understand. The second is to simplify the actual mechanics and administration of taxation. In opening the debate, the Minister said that changes to tax policies would continue to be dealt with in finance Bills in the usual way. I hope that the Minister will take to heart that the rewrite group hopes to apply itself to all of the output of tax legislation. Therefore, following the successful introduction of the Bill into Parliament, perhaps "the usual way" will not continue quite as it has in the past.
	It is also notable that the joint committee recommended to the procedure committees of both Houses that the joint committee should be renamed the Joint Committee on Tax Law Rewrite Bills in order to make that distinction. The authors of the Bill wisely point out that it is better to achieve something real than to fail through being over-ambitious or trying to do too many things at once. Although chapter after chapter of the Bill is admirable for the clarity of its language and the consolidation of the previous legislation, which was scattered among various Finance Acts--the table of repeals is four pages long, which is a staggering achievement--the Bill continues to distinguish between buildings and plant and machinery, between software and hardware, between cars and other vehicles, between short and long-life assets and all the other complicated aspects that politicians down the ages have decided are essential to the proper workings of the capital allowance system.
	That is the root of the issue that the project has sought to address and that various noble Lords have talked about today. The system is based on the notion that tax relief should be given to behaviour that is to be encouraged and that behaviour that is to be discouraged should be taxed. It is then incumbent on the Treasury to define carefully those who should receive the relief or be punished with the tax. The result is the complexity that all noble Lords who have spoken this afternoon have referred to.
	To continue in a cross-party spirit, in his evidence to the Treasury Sub-Committee, my right honourable friend Kenneth Clarke, the instigator of this Bill, said that he believed in a simple tax structure at the lowest rates that can be achieved, with no tax breaks, no complications and no distortions. He also said that he was against micro tax measures to try to make people behave in ways that they would not otherwise behave in. He was against taxes to stimulate investment in specific items, because that resulted in a very complicated structure.
	Chancellor Brown is by no means the first Chancellor who has sought to use the tax system to achieve social objectives. My noble friend Lady Thatcher staunchly defended mortgage interest tax relief to encourage home ownership and both Conservative and Labour Governments have introduced incentives to encourage saving, such as tax-exempt special savings accounts, personal equity plans and individual savings accounts. The present Chancellor has introduced numerous reforms to make work pay, as he puts it, most notably the working families' tax credit.
	The result of all that is what my honourable friend in another place, Andrew Tyrie, calls the "unstoppable juggernaut" of new tax law. To overcome those difficulties, to which many noble Lords have referred and which this exercise is about, I underline the request of my noble and learned friend Lord Howe that resources should be provided or perhaps increased to ensure that the initial enthusiasm of the rewrite project is sustained. That is reasonable. Compared with the high compliance costs in the tax management industry, the Government's modest investment in the project must be worth while. We urge them to continue with it and they show every sign of doing so.
	It is essential that those involved remain independent of the Government and, as far as possible, able to focus exclusively on the project without being removed to assist with Budgets or other Treasury matters. Unless all Finance Bills are drafted within the rewrite principles, we shall continue to take one step forward and two steps backwards, as my noble friend Lord Northbrook said.
	The noble Lord, Lord Newby, asked about timing. I think that my noble and learned friend Lord Howe said how the new Bills were to appear. When they appear, their terms will be arbitrated over and scrutinised by the Joint Committee on Tax Simplification, now correctly renamed the Joint Committee on Tax Law Rewrite Bills. I hope that your Lordships agree that that is an excellent forum and procedure for such examination.
	The Opposition congratulate all the members of the review team on their efforts and we give the Bill our full support.

Lord McIntosh of Haringey: My Lords, it is a great and unusual pleasure to be able to respond to a unanimous debate. I thank all noble Lords who have spoken for the support that they have given to the Bill. Much more importantly, I thank them for the support that they have given to the project since it has been in existence. I acknowledge that the Bill has been a long time coming, as the noble Lord, Lord Newby, rightly said, but it has been warmly welcomed by those who use tax legislation as a substantial achievement in its own right and a sign of continuing commitment to the rewrite project.
	I echo the tributes that have been paid to the noble and learned Lord, Lord Howe of Aberavon, who inspired the project. I was glad to hear the noble Lord, Lord Saatchi, remind him that he took an interest in the issue as early as 1964. I also pay tribute to the other members of the project committee, the many bodies and individuals who support the work by taking the time to comment on the draft legislation, the project team at the Inland Revenue, to whom the noble and learned Lord, Lord Howe, paid particular tribute, and parliamentary counsel, who have lent a senior member to the project for a considerable period.
	The noble Lord, Lord Newby, correctly said that the time taken reflected the inevitable complexity of the project. This is chapter one and it has taken five years. We are not going to take quite as long on future projects. The noble and learned Lord, Lord Howe, has already mentioned some of the future work. We intend to publish a draft Bill on employment income in the autumn of 2002. There will also be further work in 2003, although it is not yet as well defined as we would like. Meanwhile, the project will be looking at PAYE regulations, which, although it does not affect primary legislation, is an important issue that deserves a great deal of attention. The noble Lord, Lord Northbrook, asked about capital gains tax. The project will also deal with that, but I cannot say when.
	It was important that the noble and learned Lord, Lord Howe, said that the rewrite project was correct to go ahead without waiting for tax simplification. I do not want to comment on whether the Joint Committee should be called a tax simplification committee or tax rewrite committee. That is a matter for the authorities of both Houses, not for the Government. Without in any way underestimating the importance of tax simplification, I think that the tax rewrite project stands on its own merits.
	The relative responsibilities of the House of Lords and the House of Commons were also mentioned. I very much appreciated the reference made by the noble and learned Lord, Lord Howe, to his right honourable friends Mr Eric Forth and Mr John Redwood. Those who wish that we did more on the Floor of the House should bear in mind the comments of Eric Forth on 15th January. He said:
	"When I see the words 'tax' and 'Lords' mentioned together in one motion, I become suspicious and wonder why we have all suffered from collective amnesia on the history of this place and on the relative roles of the Commons and the Lords, especially in respect of tax matters".--[Official Report, Commons, 15/1/01; col. 54]
	On the same day, Mr Redwood said that he wanted to increase the number of Members of the House of Commons required for the joint committee to be quorate in order to,
	"reinforce the message, which I am sure the Paymaster General wants to send, that the House of Commons is in charge of taxation matters".--[Official Report, Commons, 8/1/01; col. 72]
	Those in this House who want to extend our powers in these matters have some formidable opponents in their own party in the other place.
	The noble and learned Lords, Lord Howe and Lord Simon, and the noble Lord, Lord Saatchi, referred to the need for the assurance of continued resources. The noble and learned Lord, Lord Simon, referred in particular to the need for the availability of parliamentary draftsmen. We acknowledge that point. It is a fact that the resources being devoted to the project now are greater than they ever have been before. However, it is certainly true that, if we are to continue in the way that we wish, we shall have to keep up that record in the future.
	Interestingly, the noble and learned Lord, Lord Simon, wanted the Joint Committee to have more extensive powers, comparable to the 1949 extension of consolidation Bills.

Lord Simon of Glaisdale: My Lords, I wanted the powers to go even further; I was talking about the 1965 provision.

Lord McIntosh of Haringey: My Lords, even further. I am interested in that. Perhaps the noble and learned Lord will make that point when at some stage we come to consider the Private Member's Bill of the noble Lord, Lord Saatchi. Of course, the noble and learned Lord is going a great deal further than would the noble Lord, Lord Saatchi, in his interesting Private Member's Bill.
	I very much warm to what the noble Lord, Lord Northbrook, said about the complication of tax law. It is certainly true. He referred to the complication of, for example, capital gains tax. He referred in particular to the distinction between business and non-business assets. Of course, the preferential treatment for business assets in relation to capital gains tax is a project that we have very much at heart because we are the party of small business. I do not know whether the Conservative Party agrees with us, but, above all, it is small businesses that benefit from the definition of business assets for which capital gains tax rules are substantially relaxed.
	I believe that the trouble with those who object to complications in tax law is that, whenever they come up with a particular complication which they wish to dispose of, other people inevitably, and very often rightly, wish to defend them. Let us suppose, for example, that we say that we do not want preferential treatment for buildings in enterprise zones--an invention of the Conservative government. Either one has enterprise zones and gives them clout or one does not. At the time, many people believed that one should not give them clout. I considered that the noble and learned Lord, Lord Howe, was somewhat sceptical about some of the preferential measures that he himself introduced. However, one must have complication in order to meet policy objectives. Those policy objectives are loudly urged by those who are concerned with them.

Lord Howe of Aberavon: My Lords, I wonder whether the noble Lord will allow me to make a slightly egocentric intervention. Is he aware that enterprise zones were the joint invention of the late Nicholas Ridley and myself, supported by a former secretary of the Fabian Society, Professor Peter Hall? When we proposed them, they were denounced by the noble Lord's party as the creation of capitalist Valhallas. However, when his Prime Minister first came into office and wanted to show off "Cool Britannia", where did he take the President of France? He took him to the first enterprise zone in Canary Wharf.

Lord McIntosh of Haringey: My Lords, my company had the contract with Her Majesty's Government to evaluate the success or otherwise of enterprise zones. I remember the history very well. In very many cases, the result was that companies moved from just outside to just inside the boundary of the enterprise zone and no additional employment was created. Perhaps we should not stir up that particular corpse.
	I believe that the problem is that, whenever one examines a particular complication, there will always be people who do not want it taken away. Eleven pages of the Bill deal with relief for agricultural buildings. Is anyone saying that we should abolish relief for agricultural buildings in order to save 11 pages of legislation? I think not.
	In view of the virtual unanimity of this debate, I do not believe that it would be appropriate for me to comment further on particular points raised unless they require answers from the Government. I do not believe that they do. I acknowledge, as the noble Lord, Lord Saatchi, said, that this project was originated by the Conservative government. I urge anyone who is interested in the history of the project to read the very interesting debate which took place in this House on, I believe, 27th March 1996. That debate was initiated by the noble and learned Lord, Lord Howe of Aberavon. Again, he achieved a high level of unanimity of support for the project, not least from my noble friend Lord Chandos from the then opposition Front Bench.
	I do not go back so far as Gladstone in 1853. I believe that it took 75 years for the law of property to undergo comprehensive reform under the aegis of F E Smith, Lord Birkenhead. It has taken 75 years since 1925 to achieve this degree of tax rewrite or simplification, or whatever the House chooses to call it. However, we are grateful to all those who have taken part. I might almost give the last words to the noble and learned Lord, Lord Howe, by quoting from his Hardman Memorial Lecture about what he meant by "success". He said:
	"We can now be seen to be delivering a product that is indisputably an improvement on the previous chaos. The draft Capital Allowances Bill, which the Rewrite team produced in August this year and which should be presented to Parliament before Christmas"--
	we lost that deadline; at least, we lost debate in Parliament before Christmas--
	"has been widely acclaimed".
	I agree. The Bill will make matters better for everyone who uses tax legislation. It is an excellent piece of work. I congratulate the noble and learned Lord, Lord Howe, and all involved in the project. I commend the Bill to the House.
	On Question, Bill read a second time; Committee negatived.

Health and Social Care Bill

Lord Hunt of Kings Heath: My Lords, I beg to move that this Bill be now read a second time. Although we are starting our debate rather late in the afternoon, I am delighted that so many Members of your Lordships' House have put down their names to speak. The Bill should not be seen in isolation. It is but one piece of the jigsaw which we are putting together to modernise and reform the NHS in order to make it a world-class service fit for the 21st century and responsive to the needs of the patient.
	The NHS Plan is the route map for the NHS and it explains how we will improve and increase the capacity of the NHS, how we will provide incentives for the NHS to perform well and how we will empower patients. It explains where the new money will be spent and what changes will be made, and it maps out future work programmes. It is the clearest declaration of faith by the Government in the future of the NHS and in the people who work in it.
	The Bill now before your Lordships underpins those plans and is an important part of NHS modernisation. It is about breaking down barriers and building new partnerships. That is why the powers in the Bill to establish new contracts for pharmaceutical services and to extend prescribing will help to break down the barriers between staff groups and give professionals the opportunity to make the most of their skills and deliver better services to patients.
	The need to break down traditional barriers also underlies the proposals for care trusts, enabling health, social services and other health-related local government functions to be delivered seamlessly. However, the most important barrier which the Bill seeks to address is that between the patients and the health service. The radical changes in this Bill will underpin the involvement of the patient and the wider public in the NHS, will give patients real influence in the way that the NHS is run, and ensure that there is independent support available when they need it.
	At the same time, the Bill introduces new safeguards for the use of information about patients. The Bill is about getting the right incentives and levers into the NHS to encourage and support modernisation. The powers to make performance payments and supplementary payments direct to trusts will underpin the move towards earned autonomy. Health authorities will have the powers they need to develop the local primary care workforce, which involves managing the numbers of GPs to ensure that areas where there are too few doctors are in a position to do something about it. Health authorities will also be given much greater autonomy to tackle problem GPs.
	The Bill is about fairness. While much of our discussion is likely to focus on the NHS, the Bill makes real and important changes to social care. Free nursing care and wider access to deferred payments together with the three-month capital disregard offer a fairer deal for funding long-term care.
	This is a far-reaching Bill. It is about modernisation and change. Some of the proposals in the Bill are challenging and some address genuinely difficult issues but all take us forward in our ambitious plans for health and social care.
	Clause 1 modifies the Secretary of State's powers to set health authority allocations so that he can take into account Part 2 expenditure on family health services when setting health authority main allocations. Currently, Part 2 expenditure, which consists of fees and allowances paid to GPs and other family health services contractors, is not taken into account when determining allocations; it is simply paid out in response to contractors' claims. We have asked the Advisory Committee on Resource Allocation to develop a new single funding formula that produces "fair shares" targets including Part 2 GMS expenditure so that it can be taken into account in the allocation process. The practical effect of that power is that it will enable additional resources to be targeted at areas with relatively few GPs.
	The aim of Clause 1 is to provide a financial incentive to health authorities to manage resources across primary and secondary care. The powers provided in Clauses 21 and 22 will give health authorities new levers to manage the development of primary care. Clause 21 will abolish the Medical Practices Committee, which is currently responsible for deciding whether a vacancy for a GMS general practitioner can be created in a given area. Clause 22 will give that responsibility to health authorities. While the MPC has had some success, it has not been able to encourage GPs to work in more deprived areas. Health authorities are better placed to make local decisions about the health services for local people, and transferring the power to declare vacancies for GPs is an important new tool for them to use in managing the development of local health services.
	Clauses 2 and 3 underpin our proposals for earned autonomy. Clause 2 allows for the introduction of more flexible arrangements for making performance payments to health authorities than is currently possible under the powers contained in the Health Act 1999. Clause 3 will allow the Secretary of State or health authorities to make supplementary payments to NHS trusts and primary care trusts. That new power sits outside the existing arrangements for NHS contracts and offers a less bureaucratic model for making performance payments or direct investment in the NHS infrastructure. The NHS Plan sets out proposals for a performance fund, in which all health bodies receive their fair share of the fund, but good performers will be given greater freedom over how to spend their share.
	Clauses 4 and 5 are both concerned with providing new powers for the Secretary of State or the NHS to invest in companies. Clause 4 enables the Secretary of State to invest in public/private partnership schemes to provide services to the NHS. That will enable us to launch NHS LIFT, which is a public/private partnership that will raise up to £1 billion to improve primary care facilities, particularly in deprived areas.
	Clause 6 reflects the Government's desire to see local freedoms on pay and to operate within a national framework, and it brings NHS trusts into line with the position for health authorities and primary care trusts.
	Importantly, the Bill implements the NHS Plan proposals for strengthening public and patient representation in the NHS. Consultation before the NHS Plan revealed that patients and patients' groups wanted more say about the running of the NHS, and that they wanted more help to sort out problems when they happened, not just after they had happened. The NHS Plan puts forward radical proposals to address those concerns and fundamentally strengthens patient representation.
	The first stage of the new system is to transform the support provided to the individual patient. Crucial to that effort, but not part of the Bill, are the new patient advocacy and liaison services, which will be established in every trust. They will have trust employees, be highly visible, be dedicated to resolving difficulties and complaints as they happen and provide the support that patients need in using the NHS. To ensure that they have real clout in the organisation, the services will have direct access to the chief executive. It is clear that some complaints will not be sorted out on the spot and that there is a real need to ensure that patients are properly supported when making complaints. That is why the Bill requires independent advocacy services to be established in every area--the first time that such a service has been required across the country.
	To ensure that patients' voices are properly represented in the decision-making process in the NHS the Bill will establish patients' forums. There will be one for every NHS trust and primary care trust. Clauses 12 to 16 refer to that. Those fora will be made up of patients and patients' representatives and will appoint one of the non-executive directors of the trust to which they relate, which will give patients a real say in the way in which the NHS is run. The patients' forum will monitor services and seek patients' views on those services. It will be able to inspect services, including primary care services. The forum will make recommendations to the trust and the trust will be required to publish its response. To ensure that patients' forums in a local health community make best use of their knowledge of patients' views and the local health service, patients' councils will be established to help to co-ordinate the activities of all patient fora in the local area. A common secretariat will support the patients' council and the local patients' forums.
	The Bill gives local authority overview and scrutiny committees the power to scrutinise the NHS, which will address the democratic deficit in the NHS and provide a powerful voice for local people. They will have the power to scrutinise the local NHS and joint work between the NHS and a local authority.
	Turning to the proposals about the delivery of primary care, Clause 25 provides health authorities with new powers to accredit those organisations that provide out-of-hours GP services. That is intended to ensure that such services are delivered consistently to high-quality standards.
	Clauses 26 to 33 provide new powers for health authorities to regulate GPs and other family health service practitioners. Clauses 26 to 28 will provide health authorities with robust powers to prevent practitioners from being included on a list where that would be against the interests of patients or the NHS. In addition, Clause 32 provides health authorities with powers to suspend and remove poorly performing practitioners from lists to health authorities. Decisions to refuse to admit, suspend and remove practitioners from lists will be taken on the grounds of a practitioner's unsuitability or fraudulent behaviour or because his inclusion is prejudicial to the efficiency of the service.
	Alongside that, Clause 23 will abolish the NHS tribunal that currently decides whether an individual practitioner should be removed from a list. Recent cases have shown that the tribunal is unable to deal with the most serious cases with the speed that is needed to protect patients and retain public confidence.
	Clauses 35 to 48 provide an alternative legal framework for the provision of pharmaceutical services under locally agreed contracts, which will be known as local pharmaceutical services. Those services are a key element of our programme for pharmacy, which is set out in Pharmacy in the Future and which we published in September last year. Those services will first be provided under pilot schemes, which are intended to develop and demonstrate innovative ways of providing high quality, cost-effective services to patients.
	Clause 68 will implement the recommendations of the review of prescribing, supply and administration of medicines and makes it possible for Ministers by order to extend prescribing rights to members of any recognised and regulated health profession. Clauses 49 and 51 make provision for items prescribed by certain categories of prescriber to be dispensed as part of NHS pharmaceutical services in England, Wales and Scotland. Clause 49 also proposes changes to the arrangements for dispensing across health authority boundaries to facilitate the development of e-pharmacy.
	Earlier, I talked about the need to break down organisational barriers. We know that some organisational barriers can make it harder to provide patients with integrated care and treatment. Clauses 52 to 53 address some of those obstacles, allowing for the formation of care trusts, building on the partnerships we know already exist. Care trusts will be new bodies formed out of partnerships between health and social services, providing seamless care for people with care needs that cross professional boundaries.
	It is essential that the NHS and local government work together if we are to deliver seamless care. I want to stress that care trusts are not a takeover of one organisation by another but a partnership of equals. Both partners will need to apply jointly for the establishment of a care trust. We will use this process and the other regulation-making powers in the Bill to ensure that care trusts work in the best interests of service users.
	While a care trust will be based on a primary care trust or NHS trust carrying out delegated local authority functions, its governance arrangements will change to reflect the new role and ensure that local authorities are appropriately represented. We want to see governance arrangements for care trusts include a minimum number of local authority members which reflect the wishes of local partners within a flexible national framework. In many ways care trusts offer a real opportunity to bring the skills and ethos developed in social care into the commissioning of health services.
	Clauses 53 and 54 provide for the compulsory establishment of a care trust (or the use of the Health Act flexibilities) in response to a failure to provide adequate services. Let me stress that this is meant as a backstop measure. But the power recognises the Government's duty to intervene where the NHS or local authorities are not adequately delivering essential services.
	Part 4 of this Bill concerns social care. Last July we announced our proposal to introduce free nursing care in every setting from October this year. Clause 56 will make that happen. It does so by removing the ability of a local authority to provide or arrange nursing care, thereby making it a service which the NHS has to provide or arrange in the same way as other nursing services. As an NHS service, it will be free. Nursing care is any care that is provided by, arranged, delegated by or supervised by a registered nurse except care which, although provided by a nurse, does not need to be provided by a nurse. When free nursing care comes into force, it will benefit 35,000 older people who will each save up to £5,000 a year.
	Clauses 57 to 59 concern preserved rights. People who were in residential care on 31st March 1993 are not subject to the community care arrangements that came into operation in April that year. Local councils do not have funding, care assessment or care management responsibility for them. Instead, the residents concerned have had a preserved right to a special, higher rate of income support from which they can purchase their care. Clauses 57 to 59 make the local authority responsible for providing community care to people who had preserved rights: the right to higher rate benefits for those people will then cease.
	Clauses 60 to 62 concern charging for residential care. Clause 60 means that a local authority cannot refuse residential care to someone with specified resources on the grounds that they have care and attention otherwise available to them. That is to ensure that a local authority cannot use the existence of a person's home as a reason for determining that someone does not need local authority assistance with accommodation. Clause 61 makes it possible for a person to use their own resources to "top up" their care home fees above the contribution the local authority makes. That will make it possible for people to go into more expensive accommodation than a person actually needs if the resident has the resources to make up the difference.
	The effect of Clause 62 is to make it possible for individuals who own property to defer payment of their residential care home fees by enabling a charge to be taken over property. The fees are recouped when the property is sold, or earlier if the resident wishes. The local authority picks up the bill whilst the person is in the care home. In practice this means that more people will not have to sell their homes when they go into care.
	Clause 63 makes it possible for English and Welsh local authorities to make residential care placements for their residents in Scotland, Northern Ireland, the Channel Islands and the Isle of Man. And, finally, Clauses 64 and 65 consolidate the existing legislation relating to direct payments and also extend the scope of direct payments. The regulations will increase the scope of direct payments because they will ensure that all those who are eligible and meet certain criteria, who request and consent to a direct payment, receive one. This will enable us to extend direct payments for short-term community care services, such as rehabilitation; make it easier for local authorities to make direct payment gross; and extend direct payments to disabled parents for children services.
	In Clause 67 we are introducing new safeguards for the use of information about patients. There is currently much ambiguity around the use of patient information and in this Bill we clarify the legal position. The clause does not signal any change to the Government's view on the importance of patient consent.
	Informed consent is crucial to the Government's view of how a modern NHS should work. We simply cannot move to a patient-centred service if patients are not informed and consenting participants in the services they receive. But, as we all know only too well, that is not the way the NHS operates at the moment. Much of what is done in the NHS relies on implied consent. In some cases that is appropriate; for example, sharing information within a hospital to ensure a patient receives appropriate care. But in other cases the definition of implied consent is pushed much too far. We are determined to address this. It is no small task, and the culture of the NHS will have to change radically as we move away from our comfortable habits and into practice based on real consent.
	We are taking powers to use information without consent but only after a number of very stringent tests have been passed. First, the Bill actually says that circumstances where consent is to be overridden have to be agreed by affirmative resolution in both Houses of Parliament. But before that test is applied, the Secretary of State has to be sure that the information is essential for the benefit of the NHS and the patient. And, secondly, the Secretary of State has to consult with relevant interested parties before that happens.
	Without this part of the Bill, important services such as cancer registries are at risk of collapsing as the medical professions are unsure of the legal basis which underpins the flow of patient information. I want to make clear that what this clause does not do is outlaw independent reports on NHS services or seek to restrict medical research. There would be no benefit in doing that. It provides powers to regulate the disclosure and processing of patient information, or information where it is to be used for commercial purposes. This provides a new and much needed protection from the use of patient information for purposes that run contrary to the interests of the patient and the NHS.
	This Bill, if approved by Parliament, will be a landmark for the NHS and patients. We will make progress on free nursing care; progress on patient power; progress on primary care and progress on patient protection. Above all, we will make progress on implementing the NHS Plan and put the NHS on a firmer footing for future generations. I commend the Bill to the House.
	Moved, That the Bill be now read a second time.--(Lord Hunt of Kings Heath.)

Earl Howe: My Lords, I begin by thanking the Minister for his clear and concise introduction of the Bill and for the trouble he has taken to write to me and other noble Lords with a helpful background briefing paper.
	Unlike other major health Bills of recent vintage, this Bill comes to the House with the benefit of a track record of debate in another place, albeit sometimes a truncated debate, and also after a certain amount of amendment--albeit amendments sometimes made in a hurried fashion. As such, it is a Bill which noble Lords can assimilate that much more easily and in which a number of rutted tracks have already been marked out.
	More than that, it is a Bill which, as the Minister explained, arises largely, though not in all respects, from the aims and proposals set out in the NHS plan and from the Government's response to the Royal Commission on long-term care. It is common ground between us and the Government that those policy statements contain some wholly worthy aspirations. So it is not entirely surprising, even though it may be a cause for mild rejoicing, that several parts of the Bill include measures which we on these Benches will be happy to see enacted and implemented.
	That said, whenever I sit down with a new Bill my natural tendency is to look for themes. In the case of this Bill, the Secretary of State attempted to give us some thematic pointers at Second Reading in another place when he said:
	"the Bill is about devolving power from the centre to the local".
	He went on to say that the Bill,
	"offers more support to doctors and better protection for patients",
	and contains,
	"measures that will improve services for patients",
	as well as,
	"Giving patients new powers".--[Official Report, Commons, 10/1/01; cols. 1083-88.]
	Those are noble themes. Nobody could possibly argue with them and I applaud them. However, the question is whether the play inside the theatre lives up to its billing on the noticeboard. I suggest to your Lordships that as we proceed through Committee we should ensure that we hold up the Secretary of State's themes as a benchmark for ourselves in the various aspects of the Bill which we choose to consider.
	If those words sound a little portentous, let me immediately cheer the Minister by setting out some of the more important elements of the Bill which we welcome. The provision in Clause 4 which allows for private investment to improve premises for the delivery of primary care is a sensible step that follows on naturally from the private finance initiative begun under the previous government and continued under the present one. Obviously much will hinge on the way in which NHS LIFT is rolled out, but as a concept it is surely a sound one.
	It is also good to see the extension of prescribing rights to a wider range of health professionals, a measure which again takes forward the initiatives begun during the previous government, notably in relation to nurse prescribing. I think we would all argue that healthcare professionals should be utilised by the NHS to the ceiling of their ability and training, for the benefit of patients. It is high time, for example, that pharmacists were allowed greater responsibilities in the supply of medicines. The same applies to the professions allied to medicines, such as chiropodists and physiotherapists. Again, the detail of those arrangements needs to be worked out. We look forward to the setting up of the advisory body whose task it will be to recommend proposals that are both practical and properly protective of patients.
	There are some good and useful proposals relating to supplementary lists, under which non-principal GPs, such as locums and deputies, will need to be approved by a health authority before they can practise in the relevant area. That is an essential step, not simply for the protection of patients but also to ensure that non-principal GPs are subject to clinical governance arrangements, continuing professional development, and so forth, in line with other doctors. As an aside, can the Minister tell me whether the Government are on track for laying regulations under existing legislation prior to 1st April to enable self-employed locums to be included in the NHS pension scheme with effect from the next financial year?
	Perhaps I may also renew my welcome for the provision in Part IV of the Bill that will extend free nursing care to residents of nursing homes. My noble friend Lord Astor will cover some of our concerns on the definitional and practical aspects of this issue when he comes to wind up. For now, I would simply emphasise that it is a measure which corrects a glaring anomaly in the current system. Subject to satisfactory clarification of the detail--where, unfortunately, the devil is likely to lie--it is a measure that we support.
	But let me revert to Mr Milburn's key themes: devolving responsibility from the centre, giving patients new powers and creating better services. Having just commended a number of individual features of the Bill, I must now say to the Minister that it seems to me extraordinary that the Secretary of State should be making the extravagant claims that he does for the Bill's contents. The reality is to an overwhelming extent contrary to those claims. Far from devolving power downwards, there are swathes of the Bill which arrogate power to the centre and away from doctors, managers and trust boards. There are clauses which give the Secretary of State powers to dismiss boards and hand over their responsibilities to outside contractors. There are powers to force elected local authorities to subsume themselves into care trusts when they do not wish to do so.
	Other clauses give the Secretary of State the power to dictate the terms and conditions upon which individual employees are hired and fired by every NHS body in the country. There are clauses which enable him to fine tune the budgets of health authorities and PCTs and to pay money direct to trusts without reference to the health authorities that are accountable for them. The traffic light system, about which we have serious worries, is based on the concept of so-called earned autonomy. What it amounts to is the direct central control of money from the NHS Performance Fund according to criteria which the Secretary of State lays down. In other words, the autonomy given to doctors will only be earned if they follow instructions from Whitehall.
	Whether or not one believes that the best interests of the NHS are served by an increase in centralisation, it is a positively Orwellian use of language to describe the measures as ones that devolve power from the centre; they do no such thing. Anyone with an ounce of sense can see that the way to ensure that an organisation as huge and diverse as the NHS survives and prospers is not to try to micro-manage it from the centre; it is to enable it to be flexible in response to local needs; to devolve managerial and clinical responsibility down the chain; to devolve budgets to a point which is much nearer to the needs of patients; to motivate staff by making them feel that it is their decisions that count and not the decision of bureaucrats. The Government may say that they want to decentralise the NHS but time and again we see them heading in the opposite direction.
	The Government also say that they wish to improve the protection afforded to patients. I am sure that they are sincere in that intention. But if that is so, why have they decided to abolish community health councils? CHCs, at their best, have proved themselves to be highly effective watchdogs for patients. Their successes over 25 years have been commended by none other than the Prime Minister. Certainly, CHCs are variable in the results they achieve and there is a strong argument for an element of reform which would help to bring the less good up to the standards of the best. But instead, without as far as I can see any coherent reason being advanced, they are to be done away with. In their place we are offered an array of new bodies: patient advocacy and liaison services, patients' forums, independent local advisory forums, patients' councils and local authority overview and scrutiny committees, which together are meant to perform the functions that CHCs have undertaken until now.
	Why do the Government think that a fragmented system of this kind is an improvement on the single point of entry for patients and the single point of scrutiny that CHCs provide at the moment? Why do Ministers think that those arrangements will provide patients and the public with better safeguards? Why in particular do they believe that by separating the scrutiny procedure from the complaints procedure there will be better co-ordination or a better understanding of service delivery in a local area? To a cynic looking in from outside, the Government's proposals might appear to be motivated by a desire to divide and rule. I do my best not to be a cynic. To me the proposals are simply a bewildering mishmash.
	The abolition of CHCs has been the subject of no public consultation whatever, despite the Prime Minister saying to the contrary at the Dispatch Box. There has been an equal absence of consultation on Clause 67 of the Bill. The proposals in Clause 67, which formed no part of the NHS plan, are deeply worrying. They drive a coach and horses through one of the fundamental principles of medical ethics: patient confidentiality. The Secretary of State is to be given sweeping powers to collect confidential data on named patients without consent. Such safeguards as have been promised are largely not on the face of the Bill. No proper explanation has been forthcoming as to how those powers would be used.
	The medical profession takes the view that there may well be certain rare situations in which the overwhelming public interest demands disclosure without consent but that it is for it and Parliament to define the exceptions case by case. We all understand about disease registries, but the wording of the clause runs much wider than that. As it stands, it could force GPs to pass on identifiable patient information without consent and against what they believe to be in the patients' best interests. That cannot be right, and we shall oppose it.
	We shall also oppose very strongly the other element of Clause 67 which imposes a restriction on the collection of anonymised patient data. We believe that that proposal is profoundly contrary to the public interest. Access to anonymised data is essential to the work of pharmaceutical companies in developing new drugs and monitoring the safety and effectiveness of existing drugs. To confine the restriction on data collection to "commercial purposes" as the Government have now done is no answer, as I shall argue in Committee. Again, neither the NHS Executive nor Ministers has provided a coherent explanation of why these powers are needed. There is a feeling in the pharmaceutical industry that the Department of Health simply does not understand the implications of what it seeks to do, and it is difficult not to agree with that.
	My noble friend Lady Trumpington, who was a distinguished junior health Minister in the previous government, has passed me a letter that she has just received from Sir Michael Partridge, formerly Permanent Secretary in the Department of Health. Sir Michael pulls no punches on Clause 67. He condemns it on constitutional grounds as an abuse of Parliament; he condemns it on its alleged merits, in that it will not benefit the NHS one iota; and he condemns it for its wider implications, in that the powers in it are completely open-ended. He states:
	"In my 35 years of assisting Ministers to prepare and enact Bills and regulations I never saw the like of what is now proposed . . . It is profoundly objectionable".
	In Committee we on these Benches will take our cue from Sir Michael.
	With the notable exception of Clause 67, this is a Bill which for the most part is underpinned by worthy aspirations, but it has been spoilt by the almost instinctive desire of the Government to centralise and control and to impose a one-size-fits-all policy on the NHS. Amid a number of useful new measures it is shot through with proposals that will do the NHS no good at all, and that is terribly sad.
	On a day when the BMA issues a press release headed "GPs' morale at rock bottom"--because of the casual and dismissive way in which they believe they have been treated by the Government--I find myself saying "if only". For if only Mr Milburn had the courage and persistence to pursue his key themes to the limit we might find very little on which we needed to disagree.

Lord Clement-Jones: My Lords, I join with the noble Earl, Lord Howe, in thanking the Minister for his helpful and succinct introduction to the Bill and his letter to us which sets out its provisions. The Bill gives effect to many of the proposals in the NHS Plan which was published last year, and we welcome many of its provisions. However, the Bill was heavily timetabled in another place. I very much regret the fact that such an important Bill may well be caught up in the rush in the final weeks before the declaration of a general election.
	We on these Benches have significant reservations, however, about a number of aspects of the Bill. First, let me say a word about what we welcome. Generally, we welcome the earned autonomy performance management scheme--the traffic-light system--but the problem is that the Government want to predetermine the proportion of trusts, primary trusts and authorities that fall into each category. That cannot be right. We also need to be assured that the criteria for the determination of each category will be both fair and achievable.
	We also welcome the provisions for greater use of nationally agreed terms and conditions for NHS staff. We welcome the opportunity that the Bill provides for modernising GP contracts. We hope that agreement will be reached, but an overhaul is undoubtedly needed. We believe that the Bill provides a framework for ensuring that that happens in a constructive way.
	The new powers of the Secretary of State to intervene in trusts and health authorities--here I very much disagree with the noble Earl, Lord Howe--are quite logical. As my honourable friend Mr Harvey said in the other place, it is surprising that they do not already exist, but new powers to make interventions from the centre must be exercised with great care. There is also the question, rightly raised by the Royal College of Nursing, of the nature of legal liability in an increasingly centralised NHS.
	Generally, we welcome the intention to tackle the problem of areas with too few GPs. However, we regret that under the Bill the Medical Practices Committee is to be abolished. However, although it has not by any means delivered a perfectly even distribution throughout the country things are a great deal better than they would have been without it. If the new arrangements are to be based on a market in which health authorities bid in competition with each other in accordance with the resources available to them there is a serious risk of over-supply in one area and under-supply in another. There is still a great deal of uncertainty about the alternative mechanisms through health authorities for performance of the functions now exercised by the Medical Practices Committee. I hope that we shall hear more from the Minister as the Bill proceeds. We very much welcome the extension of prescribing rights, pharmaceutical pilots and the creation of the advisory body, but we shall also want to look closely at how exactly these are to be regulated and make sure that the necessary flexibility is provided.
	Our first major criticism of the Bill is that it provides for free nursing care but does not take up the Royal Commission's recommendations about free personal care. We have debated this issue already in the House. A massive opportunity has been lost to improve the rights of older, disabled and mentally infirm people. Hundreds of thousands of older people will have to pay for the essential personal care that they need in their daily lives to dress, take meals and bathe. The Government's proposals to distinguish personal and nursing care are likely to be almost impossible to administer in practice. No one chooses to leave home, abandon independent living and seek long-term care in a residential setting. That choice is imposed on people by necessity, and it is unfair for the state to penalise people for it.
	The Royal Commission recommended that all personal care should be provided free, whether in a domiciliary context or a residential home. The provision of both services is essential. The overriding objective in all cases should be to preserve independent living, but the provisions in the Bill mean that many anomalies will arise. Some aspects of healthcare will be paid for in one context but not in another, whether that be physiotherapy or incontinence pads, which the NHS does not currently supply to nursing homes, or the practice of GPs charging for call-outs to residential and nursing homes and those costs being passed on to residents.
	The Government's desire to maintain a wholly artificial, wrong and illogical division between the two categories of patient is inconsistent with the provision in the Bill to bring together primary and community healthcare and social care. As they bring those organisations together in care trusts the Government have the opportunity to get rid of the artificial divisions and distinctions once and for all.
	It is entirely reasonable that people are expected to make their own financial provision for their accommodation, food and heating, but it is wrong that people who suffer from chronic long-term conditions will have to pay for their personal care, whereas others with acute conditions or in intermediate care will enjoy a different degree of financial support and have the services that they receive paid for under the Bill. Surely, it is right for the same treatment, often given in the same establishment and by the same staff, always to be provided free. We believe that the Government should implement the Royal Commission's recommendations for free personal care on the basis of an assessment of need. In Scotland the Executive has signalled a rethink of policy and looks set to agree the provision of free personal care.
	The Government make much of the fact that currently 75 per cent of those in residential care receive all or part of it free. In future, however, those figures will change drastically as the number of people with assets of more than £18,500 rises. As the BMA stated, we shall then be looking at an unfair sickness tax on older people. Already a person with an income as low as £260 per week is likely to be paying the full cost of his or her residential care. We shall argue strongly that the disregard provisions relating to the provision of care in the first three months should include all assets and not just the main residence.
	Even accepting that payment of nursing care is some advance for 35,000 people--compared with 500,000 who receive personal care--in residential homes, there are major problems with the provisions of the Bill. There is little clarity about what constitutes nursing care. We have seen a speech by the Minister which appears to say that what constitutes nursing care will be determined by nurses on the ground. That will be quite impossible to administer and does not seem to accord with the provisions of the Bill. The definition in the Bill which limits nursing care to care which is actually provided by registered nurses is wholly inadequate, excluding, as it does, nursing care provided by healthcare assistants.
	The management and delivery of care involves a variety of nursing and care staff. Who performs what task can vary depending on a person's state of health; nor is it clear how it will be provided as local authorities are now barred under the Bill from providing nursing care. There is no equal and opposite duty in the Bill on the NHS to provide it. What, if anything, therefore, will the duty of care trusts be?
	If these limited provisions are to operate properly, a proper assessment process is required. But in the Bill there is no sign of that. The Secretary of State said that there will be constant assessment of the individual's nursing requirements. How? An initial assessment will not be adequate by itself because a person's needs may change from day to day.
	The Government do not even know what the cost of their current proposal is. No effort has been made to measure the true cost of free nursing care and no assessment has been made of the level of need.
	The issue of care of older people is closely linked to the question of age discrimination. On these Benches, we have long accepted the case made by Age Concern in a series of reports on the treatment of older people in the NHS, from Turning Your Back on Us in 1999 to the most recent report Speaking Out in December last year. The Bill is another opportunity for the Government to accept the need for a clear duty not to discriminate. We shall be pressing hard for that opportunity to be taken.
	Secondly, I turn to care trusts. Although we welcome the fact that the Bill creates care trusts that bring together social care and primary and community healthcare, we have some misgivings how that will be achieved. Generally, the creation of these trusts is to be welcomed. The Liberal Democrats have long supported the integration of health and social care. The formation of care trusts provides a constructive way in which to do that. But care trusts must be genuine partnerships between the NHS and local government. They should share responsibility for a jointly accountable body. We have doubts, therefore, about the concept of compulsion enshrined in Clause 53.
	Furthermore, the Bill leaves open the possibility that NHS services provided through a care trust could be charged for. For example, an Alzheimer's disease or dementia sufferer receives a service free in an NHS facility, but could suddenly find himself or herself in a private or local authority facility paying for the same respite service. The Bill must ensure that care trusts do not allow new charging policies which disadvantage patients, users and carers.
	Thirdly, there is the question of CHCs. We are, on these Benches, extremely concerned about the abolition of Community Health Councils, and, more specifically, about the manner in which their functions will be re-distributed. We do not deny that there is a need for a major reform of the whole function. As I made clear in the debate initiated by the noble Lord, Lord Harris of Haringey, on the subject last year, we are open about the need for reform of CHCs. After all, the Association of Community Health Councils sponsored the publication of the report of the Commission on the National Health Service, chaired by Will Hutton and debated in this House last year, which recommended far-reaching reforms. That report admitted that there were a number of flaws in the operation of Community Health Councils; there were differences in availability and commitment of services from CHCs; there were variable standards; and there were limited statutory rights available to CHCs, particularly in primary care.
	The CHCs have admitted that the handling of complaints has been one of the weakest areas of their performance, but there is no statutory duty on them, and there have been inadequate funds for that task. Despite having heard the Minister tonight, it is still not clear what the new system to replace CHCs will be and how it will fit together.
	The first element of the jigsaw puzzle is the patient advocates--PALS. They will be within the hospitals and the trusts and are really part of a customer service function for the trusts. There will also be patient forums. These will be serviced also by the trusts. They will be consulted on local services. Scrutiny will be provided by local authorities. Now, after the Report stage in another place, we know that there will be independent advocacy services. We also know that there will now be patient councils, each a federation of patient forums, but still not guaranteed any independence.
	All that is meant to link in with an independent complaints procedure. But since the report of that review has not yet been published, we do not know what shape it will take. We do not even know, because Ministers have been unable to say, what the budgets of the new bodies will be, compared with the resources currently available to the CHCs.
	CHCs currently have combined budgets of £23 million. It must be said that that is not enough. But some estimates have put the total cost of the new bodies at over £100 million. What will the real cost of these reforms be? Can the Minister tonight give us an indication?
	The Bill destroys the comprehensive role of the CHCs, leaving a Humpty-Dumpty arrangement in its wake. It substitutes a series of bodies that, in general, lack the teeth or the authority to act independently on behalf of patients. The fact is that the Government's reform plans to replace the CHCs do not hang together at all. After all, they were an unsatisfactory afterthought in the NHS plan.
	Finally, there will be a great deal of debate on Clause 67 in the course of the passage of the Bill. My noble friend Lady Northover will deal with matters relating to the Secretary of State's powers to restrict anonymised data being released.
	With regard to the release of confidential patient information, your Lordships should know that we, on these Benches, are wholly committed to ensuring that cancer and other disease registries can continue with their activities. There is a major public interest in ensuring that they have the necessary exemption fron having to seek informed consent. We welcome the assurances about that aspect of the clause that have been given by Ministers, in terms of the creation of an expert standing advisory committee and other safeguards, including the requirement for an affirmative order if regulations are to be passed. But we are very concerned to ensure that legal exemptions can be in place for these registries before the GMC guidelines on the use of confidential information take effect this October.
	The GMC is promoting that issue in an entirely constructive manner. We welcome the Minister's statement as regards these cancer registries tonight. As the Commons Science and Technology Select Committee stated,
	"high quality data on incidence and outcome of cancer is an essential tool in the study of cancer".
	Cancer registries are a vital instrument in collecting and providing that data. We entirely agree with the Science and Technology Select Committee when it strongly recommended the introduction of the necessary legislation to grant that exemption.
	In conclusion, this is a complex Bill. While we have a number of key objections, as the Bill passes through the House we would judge each of the provisions of the Bill on their merits.

Baroness Masham of Ilton: My Lords, I thank the Minister for his introduction of the Bill. I look forward to the Minister's answers to the many queries and questions which I am sure will be forthcoming. As there seems to be so much concern about the proposed abolition of community health councils and the fragmentation of patient support, I felt that I should add a few words to this important debate. In my view, there is nothing more vital than health, be it animal or human.
	Over the years, I have served on a CHC, a regional health authority and an FHSA--Family Health Service Authority. Every time there is a change, there is disruption and insecurity and extra costs are involved, which take away from direct patient care. Over the years I have felt that the name "community health council" has been misleading. Why cannot the CHCs be renamed patient health councils or people's health councils and be built on and strengthened? If the patient's watchdog is dismantled altogether, it will be a waste of many years' work. Patients need a direct and simple access point for help when they need advice and support. This body should, above all, be independent of any health trust or health authority. The Government should have learnt about the need for independence from the Bristol cover-up, which proved to be so tragic.
	A stronger role for public advocacy is envisaged, which I support, as does the BMA. But why cannot that be a section of the patient or people's health council? One of the criticisms of the CHCs has been that they did not have teeth. The Government could give them more duties and more funds. One duty, as an independent body, could be looking at the cleanliness of hospitals and the standards of patients' food. Unless an independent body does that, no one will speak out on behalf of patients.
	An example of internal petty practices that occur in hospital was given to me the other day. I met the surgeon in charge of the A&E critical care unit at the London Hospital. The London Hospital is in need of rebuilding and has had great difficulty in keeping infections under control and the hospital clean. This dedicated person who had the patients' needs at heart had put a white rubber floor in the critical care department so that dirt could be shown up and it would be kept clean. But the new floor was removed. When people try to fight hospital dirt and infection, they need encouragement, not a negative destructive approach. That is why independence is so necessary. An independent free spirited committee can bring in a breath of fresh air. If the members are silenced by the hospital management, they will not be able to speak out on behalf of patients and their presence will be pointless.
	I hope that the Government will think again about dismantling CHCs and will keep them as an umbrella for a strengthened user/patient council, incorporating the patients' advocacy and liaison services. The powers, membership and terms of reference of the Government's new proposed bodies are to be left to regulations. When patients should come first, this vagueness does not seem acceptable.
	So many tragic cases have been highlighted by the press recently. Is it not time to build the confidence of the users of the NHS by giving them a united body that they can depend on for help and support? The professional bodies, such as the BMA, the Royal College of General Practitioners, the Royal College of Nursing, the college of physiotherapists and occupational therapists, and others have support from their colleges. Surely the patients must have an independent watchdog with a clear, strong bark that is listened to so that complaints are acted on in a quick and efficient way.
	The Government should not feel threatened by patients. Everyone should be working for their overall well-being. But I hasten to add that there are some very difficult and demanding patients. An independent body should work closely with hospital trusts to help alleviate and solve such difficult matters as violence on health premises.
	If there are no plans to abolish CHCs in Wales, that will lead to more confusion and fragmentation for the public. Surely we need a united National Health Service with similar bodies to help the public with their many requirements.
	I hope that the Government and your Lordships will be able to find an acceptable solution to Clause 67. This relates to patient information. There is concern that the ad hoc advisory group which the Government are to set up will not report until after the Bill itself has passed through Parliament. The Bill seeks to introduce the power of the Secretary of State to make regulations in three areas: requiring the disclosure of patient information; prohibiting the disclosure of patient information--for instance, sale to commercial interests--and requiring patients to be given a copy of certain information about them. These regulations could override any common law duty of confidentiality. With an anticipated huge rise in very private genetic and other information about patients, the Catholic Union has thought that the right of access to such sensitive information should be at the discretion of that individual, with very few legal exceptions.
	It is important to find the right and acceptable balance that will benefit everyone who needs information. I have found recently as an employer that it has been impossible to get any information from our doctor's surgery after a member of staff was off sick for five weeks. The member of staff signed a form to say that he was happy for the employer to have the information. There was no reply from the surgery. It transpired during investigations that an old TB lesion was found on an X-ray which he did not know he had had. As there was concern from other members of staff who had been in contact with him, we wrote again to the surgery, with his permission, to see that everything was safe. We never received a reply.
	It seems that there are grey areas relating to patient information and doctors. Patients and interested people such as employers are not sure about the correct procedures. I should be grateful if the Minister could tell the House what the Government propose to do to get the balance right.
	There is so much in the Bill that makes one suspicious that elderly and disabled people may be worse off with care trusts. Care trusts could mean that for the first time services provided by the NHS would no longer be free at the point of delivery. I am sure that the NHS should remain responsible for funding long-term healthcare, including both medical and nursing care, wherever that is provided. If that does not happen, then there should be an insurance scheme so that people needing care do not have to live with endless worries as their conditions worsen. Severely disabled people in some districts are now not able to have a bath as both health and social services decide that it is not their responsibility. I ask the Minister whether he thinks that care trusts would help in that kind of situation, or will it continue to become more difficult for severely disabled people to access these kinds of services?
	I hope that your Lordships will continue to highlight the concerns about the Bill and will improve it as it proceeds through your Lordships' House.

Lord Archer of Sandwell: My Lords, one important contribution that your Lordships' House brings to the constitution is the expertise that it can assemble on any specific question which falls to be debated. For that reason we tend to arrange ourselves virtually in colleges. It is possible to predict fairly accurately which noble Lords will participate in a particular debate. By that test, I am an intruder. The noble Baroness, Lady Masham, is a distinguished and well-informed member of that college. I am not. It is not often that I am emboldened to intervene on matters relating to the health service. Perhaps I may, in a single sentence, both explain my intervention and declare my interest.
	I am privileged to be president of Methodist Homes. It used to be called Methodist Homes for the Aged, but we felt that the last three words were too restrictive and gave a rather misleading impression of all that we do. A few years ago we changed our name. Over the 58 years of our existence, we have acquired some expertise in care for those suffering from dementia, as I am sure that the department of my noble friend will testify.
	I am aware of the calls on my noble friend's time, but may I recommend that he read the report of the Audit Commission, published in January 2000, entitled Forget Me Not: Mental Services for Older People, or at least, if he will, the section on dementia, which devotes a page and a half and a case study on the Methodist Homes special residential home at Mayfields in the Wirral.
	I venture to intervene, therefore, on a narrow issue arising from Clause 56. Some may say that this is not a Second Reading speech but is virtually a point to be made in Committee. However, knowing my noble friend's readiness to listen and believing as I do that open government should evoke an open response from the Back Benches, I thought it better to make these concerns known at the first opportunity.
	The Royal Commission was unanimous in its view that free nursing care should be provided for people in residential homes. The present position is indefensible; namely, that nursing care should be provided free for those in hospital or in some nursing homes but not for those in residential homes. The Government have made a generous response by moving to rectify the anomaly. They are much to be commended for that.
	I understand that it does not follow that the Government should also provide free social care. We all believe in joined-up government, but inevitably distinctions arise between various needs and the responses to them. Sometimes, distinctions have to be made. I thought that the debate within the Royal Commission was well argued on both sides. I do not presume to arbitrate between them. The noble Lord, Lord Clement-Jones, who temporarily is not in his place, advanced a powerful argument. I shall not say that he did not tempt me. It requires some self-control on my part not to weigh in behind him, but I hope that he will forgive me if I confine myself to the narrow case that I have intervened in order to argue. I do not presume to intervene in the Royal Commission debate. I shall leave that to those who are better informed. Indeed, I rather feel like someone on a battlefield who crawls in between the opposing armies, not to support one side or the other but merely to carry a civilian casualty to safety.
	I do not even challenge the criterion of nursing care which the Government propose to adopt. The Government have gone further than the Royal Commission recommended. Nursing care will include not only tasks carried out by a registered nurse but tasks delegated by a registered nurse. I intervene to make only the narrow point that a distinction which may make sense in one situation may not be appropriate everywhere and throughout infinity.
	Dementia patients are among the most vulnerable members of the population. They may alternate between periods of clarity, what one may be tempted to call normality--although who among us is normal all the time?--and times when they slip away from the world, when they may regress to earlier periods of their lives and when they are wholly dependent on the care of others. The treatment to which they respond may vary from medication to patient conversation and stimulation which will bring them back to life. To distinguish between those two kinds of treatment is the most irrelevant of artificial distinctions.
	It is certainly not a distinction between skilled and unskilled treatment. Some of the carers in our homes are highly trained and, through experience, they have acquired a way of relating to a patient which can virtually work miracles. Perhaps I may refer again to the Audit Commission report and quote one sentence from its study of Mayfields:
	"Staff training and support are fundamental to the regime of the home in which relearning and maintaining living skills is emphasised at all times".
	One may see a patient who is totally switched off and totally unresponsive--verging more on the unconscious than on a person who can respond to the environment. A month later one may return to see that patient taking part in a game, enjoying a role in the community or telling someone about a treasured memory. If that is not healing, then the word has no meaning. It may entail understanding what lies behind apparently irrational conduct. For instance, one lady became restless just before four o'clock each afternoon. She would get up and wander off. It then emerged, through patient conversation, that that was the time when she used to collect her grandchildren from school.
	It may be a time-consuming form of treatment, time spent on a one-to-one basis, but it may be the difference between life and death. A dementia patient is not only one more person in need of social care and the financial cost cannot simply be absorbed into the statistics about the numbers of elderly people. It is a specific need to which a distinction between treatment by a registered nurse and treatment by someone else is not meaningful. But if it becomes known that treatment for a patient in a nursing home is fully funded, whereas treatment for the same patient in a residential home is not, not only is there an anomaly, but there will be an incentive to choose the more expensive option of the nursing home.
	What is done at Mayfields is as much a healing process as what is done in a hospital ward or a doctor's surgery. It is every bit as truly a treatment as giving an injection or measuring out tablets. It is as time-consuming and expensive. The cost is beyond the resources of most patients and most social care budgets. It is an appropriate concern of the health service and I hope that my noble friend will reflect on it.

The Lord Bishop of Lichfield: My Lords, I should like to build strongly on what was said by the noble and learned Lord, Lord Archer of Sandwell, and the human realities to which he referred.
	It so happens that, for the past 13 years, my family and I have been caring for my wife, who struggled with Alzheimer's disease at home. She died several months ago, but peacefully and at home. Throughout those years we were helped greatly by many people in the NHS: district nurses; GPs from the local practice; and a very good consultant who came to see us from time to time. Their help as professionals was invaluable.
	However, as many noble Lords will know, a huge amount of time is taken up by that daily, hourly, grind that the Royal Commission called "personal care"--that care of a person, often through the major part of the day and night, which is what the stuff of nursing is about, so vividly described by the Royal College of Nursing. I refer to bathing, feeding, dressing, toileting, comforting, communicating, changing dressings, checking for pressure sores, assisting with lifting and so forth. It is this personal care which the Royal Commission recommended should be free, along with nursing care. In other words, in some cases we need at home what the noble and learned Lord, Lord Archer, has so movingly proposed should be available in a nursing home.
	Why have the Government rejected this? It is perhaps worth recalling the Royal Commission's definition of "personal care".
	"By 'personal care' ... the Commission mean the care needs which give rise to the major additional costs of frailty or disability associated"--
	but not always--
	"with old age".
	This type of care may be delivered by people who are not registered nurses, in particular by family members, by care assistants and by agencies.
	I share a widespread disappointment that the Government seem to have decided to reject that key proposal of the Royal Commission. Not only does this perpetuate the artificial distinction between personal care and nursing care, to which the noble Lord, Lord Clement-Jones, referred; it also runs counter to all that the Government have said elsewhere in the NHS Plan about breaking down the barriers between health and social care, which, as they have said, can often be a source of confusion to people in society.
	This leads me to the final and key point of what I wish to say from my own experience. Many people in this situation simply long, if possible, to be at home. My wife longed to be in her own home. This is because, even with a person suffering from dementia, the sounds, the routine, the voices--voices that perhaps an Alzheimer patient can remember from the past--can take away, as nothing else can, the great ghosts of anxiety and confusion. Free personal care at home can foster well-being at a very deep and important level. Surely, while it can be carried out, it takes away the pressure on hospital wards and residential homes. That is why personal care is so vital.
	The introduction of the Royal Commission concludes with these words:
	"The moral test of Government is how that Government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life--the sick, the needy, and the handicapped".
	That kind of moral choice is, I submit, integral to what our debates and reading of the Bill are all about.

Baroness Carnegy of Lour: My Lords, we have just heard two very moving speeches from noble Lords, based on their own experiences, on one aspect of the Bill. Perhaps I may first speak more generally about the direction in which three or four aspects of the Bill seem to be taking the National Health Service. I shall then raise one question of detail concerning Scotland.
	Listening to the Minister week by week, as in his able and assiduous way he answers Questions and makes Statements on behalf of the Government and describes the system, it is not difficult to see why the National Health Service has become so impossibly difficult to manage and why the costs are so difficult to contain. Some of the obvious factors, such as the ever burgeoning possibilities of technology and medicine generally, are unstoppable by the Government and must somehow, to an extent, be accommodated, but there are two underlying, obvious and long-standing problems which can be addressed.
	First, the National Health Service is far, far too big a business to manage in detail from the centre. Secondly, the system means that those who work in the National Health Service constantly have to respond to changes in the way they operate because of initiatives deriving from a political agenda. Until a government, of whatever persuasion, come to power with the courage to free the system--to free managers and health professionals to meet their local needs locally as they think best and to be judged on the outcome of their work as it affects patients rather than on their ability to conform to the system as a whole--until such extremely radical change happens, the problems, I fear, will continue to grow.
	Given that perhaps somewhat unnerving context, how will the Bill affect the direction of the National Health Service? Some of its proposals go the right way and are very welcome--my noble friend Lord Howe has enumerated several, including, of course, allowing pharmacists and other professional people to prescribe; that is a decentralising, freeing-up measure--but if the overriding need is to decentralise and depoliticise the National Health Service, the Bill seems to be moving in the wrong direction, despite what the Secretary of State seemed to claim in another place.
	Clause 6 is an example to which my noble friend referred. At first glance it looks good; it looks like decentralisation. National Health Service bodies will be able to employ whom they want to employ on the terms they decide. Having read that, one supposes that those terms will have been negotiated locally. But, reading on to the next part of the clause, it turns out that this must be done in accordance with the regulations and directions issued by the Secretary of State. He must have consulted nationally, which presumably means that he must have negotiated nationally. That is centralisation, not decentralisation.
	Another example is the concept of "earned autonomy" for health authorities, which the noble Lord, Lord Clement-Jones, who is not in his place at the moment, seemed to favour very much. That is a system to reward success and penalise failure, as set out in Clause 2. Presumably this is an attempt to draw on how incentives work in the business world, where, in a free market, with freedom to innovate, success brings the opportunity for more success, to the benefit of all concerned. But here there is no free market, and so under Clause 2 success in the National Health Service will be measured according to how well a body has conformed to stipulated criteria, and those criteria will be set by the Secretary of State. Whatever else is the effect of earned autonomy, it will certainly discourage innovation and enterprise and will be massively centralising.
	As to the need for less meddling by politicians, the Bill brings local government councils formally into the heart of the National Health Service system, I think for the first time. Clauses 8 to 10 mean that local government politicians will form a committee, under regulation, charged with scrutinising what is going on in their local National Health Service and, where they see fit, making recommendations for change. Under local government rules, most of their discussions will take place in public.
	One can imagine the scene--I am an old local government girl myself--if perhaps, contrary to the view of the scrutiny committee and its parent local government councils, the Secretary of State declares their local National Health Service body as having failed and wheels in new management. An enormous balloon will go up. The local government associations are pleased at this proposal. We shall examine those clauses carefully in Committee. But for the time being we should note that there will be a whole new political dimension with which National Health Service staff will have to cope. That is inevitable.
	It seems to me that there will be at least one increase in trade union and professional association politics in the National Health Service if Clause 56 is left as it stands. A number of speakers referred to the proposal that nursing care in nursing homes should be free. It is a good proposal. "Nursing care" is defined as,
	"care provided by a registered nurse".
	The Minister added something extra in his introductory remarks. I shall read his remarks with interest in Hansard. I do not think it is in the Bill, although I may be wrong.
	Surely there will be pressure in nursing homes to maximise what registered nurses do for patients, because it is free, and to minimise what others do because it has to be paid for. I may be reading this wrongly, but I think it could cause a great deal of political trouble. One sees old-fashioned demarcation disputes looming. The Royal College of Nursing has already started the argument in a letter which I read today. We must surely examine that matter in Committee.
	That brings me finally to my specific question relating to Scotland. Clause 63 rightly proposes that there may be regulations enabling someone resident in England to be placed in a nursing home in Scotland, perhaps to be near his or her family. Should the Scots Parliament finally decide, as the Scottish Secretary seems to be proposing, to provide free personal care as well as nursing care in Scotland, who will pay for the personal care of the English resident who goes to a nursing home in Scotland--the English authority, the Scots Parliament through the Scots authority or the patient? How will that transaction be seen by the patient in the nursing home? What will happen if a Scots resident, entitled at home to free personal care, moves south, where personal care is not free? How will that look to the patient? That is a question for Committee. I flag it up as a subject that we shall need to examine in some detail. It is an important devolution issue. Noble Lords know that at present I am very keen on devolution issues. I find them in all kinds of surprising cases, and I believe that this is one such case.
	No one, least of all the general public, wants the National Health Service to be more centralised, more unwieldy or, indeed, more politicised. There is a great deal of work to be done in Committee.

Lord Smith of Leigh: My Lords, the National Health Plan on which the Bill is based at last puts the interests of patients above the interests of others. For too long, the interests of organisations and professionals have held sway against those of the patient. I hope that we can use that as a judgment when discussing the Bill's provisions.
	Perhaps I may concentrate on three aspects of the Bill, two of which may be unexpected. I need to remind the House that my interest as a local government leader is in the scrutiny role of local authorities as regards the NHS and care trusts. The other one concerns the distribution of primary care.
	In terms of scrutiny, local authorities are well placed to provide the role which, as other speakers have noted, CHCs have not managed to provide consistently across the country. CHCs have done well in certain places, but across the country that is not the case: they have been reliant on whichever professional was in charge of a particular CHC. Local authorities have the ability to do that, given that they carry out certain tasks: they should look to a review of health provision, and not simply concern themselves with health organisations. That is an important distinction. They need to contribute towards the future development of health services, and not merely look at what has happened in the past. They need a positive role. In terms of public involvement, I am pleased to see the provision in Clause 11; local authorities should be playing a part in that.
	One of the experiences of local authorities in recent years has been in terms of "best value". They can perform a useful role in looking at the NHS in terms of what they have learnt about best value in their own organisations. They should adopt a robust and effective style; but it should not be confrontational--that will not get anyone anywhere, as I believe local authorities have learnt. The regulations regarding scrutiny will need to be as flexible as possible because of the boundary complexities of local authorities and the various health organisations. Where health authorities are concerned, the boundaries are rising upwards towards a sub-regional rather than a local basis. We need to be concerned about how we make sure that scrutiny is carried out as the work of the new health authorities that will emerge. Clause 8, dealing with the distribution between district and county councils is relevant in those areas; however, in metropolitan areas county councils do not exist, and arrangements need to be found.
	One aspect of scrutiny that needs to be raised is the fact that many decisions and activities of health authorities are carried out on a regional basis rather than on a local or sub-regional basis. Who will be responsible for reviewing and scrutinising the work of the NHS at regional level? I am sure my noble friend is aware of the work of the regional assemblies and chambers which the Chancellor is entrusting with the greater scrutiny powers of the RDAs. Perhaps this is a role that they could take on.
	Turning to care trusts, it is common sense that, for patients, the roles of community care and medical care need to be integrated. An elderly person who may enter the care system could be referred either through the social services system--through a social worker--through a general practitioner or, if he or she has an accident, through the accident and emergency unit of the health trust, or through a consultant in geriatrics who is called in to examine the patient.
	Care needs to be provided by a number of agencies, and that needs to be done carefully and considerately. For me, this was a theoretical problem until recently, when an elderly relative began to need the support of the various agencies. The process has worked so far, but only just, and there has certainly been one weak link in the chain. It may be that I am more able to push for things to happen than other people are.
	We can work through the provisions of the Health Act 1999, which provided a number of powers in relation to joint working. In many areas the provision is working well. The current Bill attempts to bring in organisational simplicity. That is greatly to be encouraged. However, we need to make sure that we work on what is happening at present and that we build on the experiences of local authorities and health organisations.
	As my noble friend implied in his introductory remarks, he recognises that there are concerns, particularly on the part of local authorities, regarding the governance arrangements in the new care trusts. They appear to be NHS bodies. Although we welcome the comments regarding the involvement of local authorities, we are concerned about how they will operate. I hope that my noble friend understands that this is not merely a concern about not wishing to give up control. Anyone who becomes involved in partnership recognises that the first lesson is about giving up control. We are concerned about outcomes. NHS organisations reflect the culture within the NHS. Effectively, we can say that it is an "ill-health" service, geared to dealing with people who have medical problems and medical needs. Health prevention and community care may not stand up to the pressures of acute services within a new care trust, and that is what concerns local authorities. I can give your Lordships an example from my area. With the help of the health authority, my local authority has worked out a system of what we call, "fitness on prescription", where people who may have had a heart attack are given the ability to go to a local authority or to a gym so as to get some prescribed regime of diet and exercise to try to improve their general health.
	When primary care groups were introduced in my area, the first question that those concerned raised was whether or not that was necessary expenditure. We were concerned about that development. My area is interested in setting up a care trust, but we need to ensure that we can achieve the objectives that we are set as a local authority in providing community care, and that what we propose is not considered as being just a new way of providing acute care. I believe that the general principle is that partnership cuts both ways.
	I have asked my noble friend the Minister a question and have been communicating with him regarding my concern about the distribution of general practitioners across the country. I do not quite share the view of the noble Lord, Lord Clement-Jones, that the MPC has done a good job in this respect. It does not look like that from the point of view of certain areas. A study of health statistics will show that there is a very simple correlation between poor health statistics and a low number of general practitioners. Of course, there are other factors that also mesh in; for example, the social economic factors of the area are keys to health statistics. Therefore, health provision is most important.
	Instead of areas of high deprivation and health need having a larger number of GPs to help to counteract the situation as one might expect, the truth is exactly the opposite. Areas of high deprivation in the North usually tend to have fewer GPs. This means that those GPs have larger practice lists in areas that already have high health need. Clearly this becomes very unattractive to them. The problem is urgent. It is not only a current problem; but also, as I have told my noble friend, the age profile of general practitioners in many areas, especially in deprived regions, needs to be considered. In my area about one-third will retire over the next five to six years--in other words, a key factor is replacing them, as well as providing for more. We need to bear that in mind.
	We must ensure that we can make general practice an attractive career, not just for areas of general affluence and pleasant lifestyle in the South and other parts of the country, but also for those areas of deprivation. We need a proper package of incentives. I am pleased that part of the Bill proposes a "lift" scheme to improve premises. We also have a high number--40-odd per cent--of single-handed practices, as against the national figure of under 30 per cent. In many old premises, old terraced properties, there are inadequate facilities. This scheme will help to produce a level of general practice that is much better than has been the case in the past. I hope that my noble friend has got this right.
	If the debate so far is anything to go by, I am sure that we shall have a lively and interesting debate in Committee when we explore such matters in detail. I want to test the Bill by the simple criteria of whether it puts the interests of patients first. If it does, I shall support it.

Lord Rix: My Lords, I hope to take and comment on this Bill as a single entity, even if that is not what it looks like. The willing suspension of disbelief was, after all, an important aspect of my theatrical career. Taken in that way, and viewed from the perspective of a person with a learning disability and their family--a role, as president of Mencap, I seek to undertake--if it works, as I assume that it is intended to work, the Bill could give rise to the following 10 bullet points.
	One: NHS bodies being judged and rewarded according to the extent to which they specify and provide equality of access for people with learning disabilities, with private sector finance being used to buttress what they do in this area, and not just on large buildings and high technology. Two: NHS bodies planning, in partnership, the health service contribution to fulfilling the ambitions of the forthcoming learning disability White Paper.
	Three: Local authorities, which share with the NHS responsibility for learning disability services, using their new scrutiny powers to look at the discharge of shared responsibilities towards people with learning disabilities. Four: representation of people with learning disabilities and their families in the brave new plethora of consultative and advisory bodies, and the issues that concern them being taken on board by those bodies. Five: independent specialist advocacy services that at last ensure a formally recognised voice for people who are not able to speak for themselves--a point that we have been stressing for over 30 years.
	Six: a place for people with learning disabilities in the new-style dental, pharmaceutical and other community services, so that special needs are better addressed in the new services than they have been in the old. Seven: care trusts, where this is the right local solution, catering for integrated learning disability services, ignoring neither health nor social care needs, and linked to housing, educational, employment, leisure and financial needs. At present, if Florence Nightingale were walking round with her candle trying to find who is responsible for learning disability health services, she might spend an extraordinarily long time in the dark.
	Eight: a charging system which, when the hard work now in hand reaches its inevitable conclusion, recognises the operational impossibility of sorting out nursing from social care needs on any fair and convincing basis, especially where intellectual disability or cognitive impairment is concerned. Nine: replacement of preserved rights to social security funding by a system that guarantees realistic funding levels and personal choice. It must not deny people both of those basics in the interests of tidying up the system.
	Finally, I turn to number 10: rules on patient information that recognise the problems and protect the interests of those who can neither access their own records nor authorise access by others. I apologise to noble Lords for that catalogue, or rather I justify it by the need to draw out issues inherent in the Bill but which have, as far as I can see, received no recognition in earlier debates in another place. If major social reform is to work, it has to work for everyone--not just for some people. That is what inclusion is about; and it is a great deal better than partial policies for limited groups.
	Perhaps I may add another tincture to my modest rose. I should like to elaborate on a few of those points, though not, your Lordships will be relieved to know, all of them. We are offered a new structure for consumer involvement. That structure now seems more likely to incorporate the essentials of independence, cohesion and clarity of purpose. However, as other noble Lords have stressed, whether it will deliver less or more than community health councils and their national co-ordinating body have sometimes delivered is open to question. I fear that I hear the distressing sound of babies gurgling down the plug-hole. Whatever the eventual outcome, it is absolutely crucial to preserve existing expertise under any new dispensation.
	It is some time since the then junior Minister for health, Mr Paul Boateng, promised people with learning disabilities--I was present at the time--seats on health authority and trust boards. I support entirely the worthy ambition in this Bill to put patients at the centre of the NHS; but that should be all patients, particularly patients whose voices are not heard by consultants and managers in the course of their normal social round. The challenge is to secure a voice for people with severe learning disabilities, or those with the physical and mental frailty of extreme old age, or severe and chronic mental health problems. That is separate from the advocacy at individual level that is needed, and which is something other than an effective customer relations department. I sense that the Government have moved on this, though every government department that gets close to saying that we need the rights to personal advocacy locked up in the disabled persons Act of 1986, draws back and acknowledges the principle without willing the means.
	On care trusts, I shall repeat my call for clarity on responsibility for learning disability services as we yet again re-organise. I have some confidence in what could happen in Oxfordshire where a specialist learning disability trust with an excellent reputation for joint commissioning moves into new relationships. When I look elsewhere and see learning disability being treated like a game of pass-the-parcel with the players constantly changing, I sometimes feel despair rather than optimism.
	The transfer of preserved rights funding from social security to social services has been presented as rationalisation and enhanced flexibility, and that is indeed part of the truth. The other part is that the individual brings less negotiating power to the negotiating table because the local authority is the purse bearer. The rationalisation of funding from this Bill and from the supporting people programme is fine if there is enough funding and if the choice of the individual is not sacrificed in transferring that individual's traditional benefit rights to the local authority to spend on their behalf. Where learning disability is concerned, we are trying both to double or treble the annual increase in new places for people to live away from the family home where most now live and to diversify the choices of accommodation and support available. In my view, therefore, it is essential that the increase in local authority responsibility should be matched by an increase in funding. Local authorities might be able to do different things with transferred money, I doubt that they can do additional things. Prospero had a vision and a very splendid vision, but he recognised that the "insubstantial pageant faded" and was no substitute for solid reality. To complement the Bill we also need a visionary White Paper on learning disability matched by a realistic possibility of implementing it.
	Finally, I turn, as the Minister will have anticipated, and as other noble Lords have done, to Clause 56. I have cause to be grateful to the Minister for his patient and helpful responses to a series of approaches from me about the free nursing care issue. He has kindly offered me a further meeting after today's debate. At risk of stating the obvious, we have moved from charges for nursing and for social care in certain settings to the prospect of free nursing care. That must be an improvement, and it carries a cost, and I acknowledge both improvement and cost. Unfortunately this indicates that where the assessment identifies nursing needs but there is no nurse as such at all, the resident has to pay despite the nature of their assessed needs.
	There are at least two other approaches which I think would make more sense. One, and much the most attractive, is the Royal Commission proposal of free personal care. The other is to look at the totality of people's needs, and for those with the highest (and, therefore, most expensive) support needs to be designated as nursing/high support cases and have their care free. I add to the most moving pleas of the noble and learned Lord, Lord Archer of Sandwell, and the right reverend Prelate the Bishop of Lichfield and say that all--I stress the word "all"--people with severe intellectual impairment, whether resulting from dementia, learning disability or progressive neurological damage, would fit this category. So would people whose severe physical disability puts them in a like position. I do not back wholeheartedly the less comprehensive approach because my heart is with the commission's option, but I air it as a distinct possibility.
	We have created a more complex world of care and support in which people who would once have lived and died in hospital now live and die in residential homes, in supported accommodation or in their own homes. We have also ensured professional overlap so that allegedly nursing functions are commonly carried out by those who are not nurses, or by those who are but because they are in a residential home rather than a nursing home are not allowed to practise as a nurse. We need, I suggest, to follow through these current realities into our financial arrangements and not to plunder modest assets above an extremely low capital threshold in order to pay for what would once have been free hospital care.
	I look forward to the Minister's response. There is much good in the Bill. No doubt the considered views of your Lordships will make it even better, and I trust that the Minister, unlike Horatius holding the bridge, will allow a certain degree of movement.

Baroness Ashton of Upholland: My Lords, noble Lords may recall my interest in healthcare as the chairman of east and north Hertfordshire health authority and chairman designate of the newly created Hertfordshire-wide health authority.
	In making my comments on the legislation before us I shall try to speak from the perspective of implementation--what will be the effect of the legislation on the NHS operation on the ground. Not surprisingly, I have views on all parts of the Bill but tonight I want to confine my remarks to a few aspects. I have chosen these because in the course of the past week I have had the opportunity to consider how each one might affect the work that we are undertaking.
	To set the scene a little, I was surprised when I became a health authority chairman to discover the level of independent working that existed within the NHS for different bodies--GPs, ambulance services, residential care, care of the elderly, hospitals and so on. One of our greatest challenges has been to get our health system to think of itself as precisely that, a system, and for each organisation to understand the impact upon the other. That in part includes holding each other to account. It is that accountability that has had the greatest impact on the operation of our services.
	The first part of the Bill I would like to comment on concerns the enhanced powers to intervene in rewarding success and dealing with failure. In my opinion this is to be wholeheartedly welcomed. In my experience, we are too slow in the NHS to recognise problems and even more so to deal with them--clinical or managerial. I have seen problems flagged up for years before being dealt with. I was particularly pleased to see in the legislation that health authorities that perform well will have the opportunity to receive enhanced resources and can also be a channel for additional resources to primary care and acute trusts. This will enable health authorities to play a stronger role in performance management and development rather than relying on a sometimes personal authority that exists within a health authority.
	My only note of caution concerns how we assess performance. Noble Lords may know that I am no fan of league tables as they currently stand. They often state the blindingly obvious and demoralise people along the way. I am not in favour of their abolition; rather I should like to see greater sophistication that demonstrates true performance and true improvement. I am though a great fan of information. I have sat through meetings to be told that a managerial process or a clinical idea are carried out because they feel right. Now I have the quality of information at my disposal to find out just how right that is and to find out why.
	My next point concerns the new powers for health authorities in relation to GPs and in particular to out of hours provision. Not only is this a problem for individual patients but it also has an impact on the use of nurse-led care for the elderly in particular, where the ability to call GPs and get a swift, high quality service is crucial. This matter has been raised with me during the past week in relation to NHS continuing care facilities on my patch. Under the new legislation we shall play a stronger role in ensuring consistently high standards through accreditation of out-of-hours cover and the power to suspend or remove accreditation where it has failed to supply that high quality service. This will impact directly on our confidence in the provision of what I believe is important; namely, nurse-led care backed by GP cover.
	I want to touch on the setting up of care trusts. In Hertfordshire we have just established, with my noble friend the Minister's permission, the Hertfordshire Partnership Trust to provide services for people with learning disabilities and people with mental health problems. I note that the noble Lord, Lord Rix, is not present, but I should say to him that I hope Florence Nightingale will not even need to light her candle in Hertfordshire to find out how to access learning disability services and the people responsible for them. The commissioning arrangements for the trust will be carried out jointly with the county council and staff will transfer into the trust through secondment.
	The setting up of care trusts is not far from where we currently are and the principles behind them are therefore to be warmly welcomed. Our ambition in setting up a partnership trust is to abolish duplication and to provide a seamless service for the people who need these services. That comes down to simple things such as how many forms they have to fill in; how many assessments they have to undergo; not worrying that funding will not be there because it falls between two different organisations; needing to get money from more than one pot and so on. Noble Lords may recall that one of my themes is joined up thinking leading to joined up implementation. This is a good example.
	It would be a surprise if today I did not touch on what has become the most famous chapter in the history of the NHS, namely Chapter 10. I have a good, strong relationship with my community health councils who have served their community well. But I wholeheartedly support the proposals within the Bill.
	Over the past 10 to 15 years I have observed the changing role of the consumer in corporate social responsibility. Consumers changed their purchasing habits to reflect their views on the environmental or social policies of the companies from whom they purchased their goods. That had an impact on shareholders, who also played their part.
	In social policy the radical shift has been of a different nature but none the less significant. In the 1970s and 1980s the problems of many social groups in society were represented through intermediary organisations rather than through the consumers or the groups themselves. Community health councils are a classic example. In most fields, the shift has been clearly towards groups speaking for themselves. The impact is much greater, the message more vibrant and--dare I say--the effect less patronising. The changes in the Bill reflect this broader change in society. Patients' forums can provide that direct access. They can speak for themselves.
	From the letters I receive and the complaints which made their way to my desk, the greatest criticism that underlies complaints made by patients of the NHS is about communication. Too often a few well-chosen words, an explanation of why someone was kept waiting or why they were given a particular treatment would have resolved the issue. Equally, if the patient had been able to object there and then to unsatisfactory food or lack of information, or to question what is happening, it would have led to a better resolution. Patient advocacy and liaison services have long been needed and it is right that they should be a function of NHS trusts. My response to their introduction is a frank, "It's about time".
	I recognise the need for real scrutiny of health services on a health economy basis. I also recognise the need for democratic legitimacy in this scrutiny. Therefore, I welcome the role of county councils and the district councils--in my case the Hertfordshire County Council--where appropriate. Health services belong to the people and until we find a better option than democracy it is right and proper, as my noble friend Lord Smith of Leigh indicated, that these democratically elected bodies should hold us to account on the people's behalf.
	I should like to say a few words about professional advocacy. There is no doubt that we shall continue to need strong advocacy services for patients. Things do go wrong and need to be addressed speedily and effectively. I am keen to see services developing that encompass some of the professional groups which have represented, for example, people with learning difficulties on, in my experience, a county-wide basis, building on the knowledge and expertise which undoubtedly resides within the CHCs.
	My small plea is for the pressure to develop good services to be assisted by the development of better communication within the NHS as regards what works. Ideas are implemented at a local level; and down the road another organisation will struggle, using huge amounts of time and resources, to reinvent that wheel. It is a challenge to get NHS people to go to see what is happening elsewhere, but the situation is not helped when they do not know where to go. The establishment of the social care institute for excellence--I believe that it will be heralded tomorrow--is a good example. One of its aims is to create a knowledge base of best practice and social care. Systematic information, encouragement or insistence that organisations share with each other all help to make the NHS more effective.
	I welcome the legislation before us for what it can do for patient care on the ground. The overriding principle of creating strong community primary care as the focus for the delivery of services is backed up by stronger voices for patients and greater powers to ensure good services delivered effectively. I wish the Bill a speedy and successful passage.

Baroness Fookes: My Lords, the Minister spoke with enthusiasm about what he regards as a major reform of the National Health Service. I do not doubt his sincerity but for someone like me who has watched a wave of reforms over the past 30 years, I hope that I shall be forgiven for a modicum of scepticism. Surely wave after wave of reforms should have solved the problem by now. If not, I doubt the possibility of this Bill delivering where others have not done so.
	My first concern is that we are too ready to throw out what we have had in the past without thinking about the disruption caused by changes. In recent years, the NHS has seen innumerable changes. One has to weigh the theoretical good that one hopes will be involved against the disruption and uncertainty of making the changes. We should be far more wary than we are of seeking to make such changes following many others in recent years. I sometimes feel that the NHS would do far better if we just left it alone for a few years to get on with the job. I realise that that is probably a futile aim.
	I turn to what the Bill seeks to do. First, I regret deeply the decision to abolish the community health councils. I agree that not all of them were as effective as they could be but that does not seem a good reason for getting rid of all of them. Surely we should seek to build on those where there has been good practice, to reform where necessary and to work on something that is now widely known. Instead, we are setting them aside and turning to other means of dealing with their problems.
	Only this afternoon, I was visited by three members of the Plymouth Community Health Council. They were adamant that they had done a good job; they could do a better job and would like the opportunity to do so. It is depressing for those who have given good service over many years that their efforts should now be seen to be futile and useless.
	What are we getting in their place? The situation reminds me of that mythical monster the Hydra in Greek mythology. It had several heads so when you cut off a head at least three others sprang up in its place. That is what we are getting here.
	Let us go through the new arrangements for dealing with patients. I refer to the patient advocacy and liaison services. It sounds slightly better when it is called PALS. The Minister explained that the Bill only involves matters which require primary legislation; and that we should consider a wider canvas. Therefore, I believe that it is fair to consider the patient advocacy and liaison services. At first sight they seem a good idea. They will be employees of the various trusts with the specific charge of overseeing patients' complaints and having direct access to the chief executive. But some patients will be put off by the term patient advocacy and liaison services. Will everyone know precisely what that means? I doubt it in some cases. If the body were called the complaints department people would get the message.
	Even today when everyone complains more than they used to do, some people will be fearful of making a formal complaint, particularly if they are a patient in a hospital at the time, or are a relative and concerned that the patient might be picked on or treated more badly as a result of a formal complaint. So one must beware of assuming that this body will be the be-all and end-all for individual complaints.
	Then there are the independent advocacy services, which, I gather, will deal with issues that cannot be readily resolved. I am not quite clear how a patient would check in to the independent advocacy services. Perhaps I have missed something. I hope that the Minister will explain, either this evening or at a later stage, how the system will work.
	Then we have what the noble Lord, Lord Rix, rightly called a plethora of other patient fora--no, we call them forums these days. There are patients forums, patients councils and the local authority overview and scrutiny committees. I find the whole thing depressingly complex and I wonder how much good those bodies will do. Above all, who will be members of those bodies? Only a limited number of people have the will, the time, the money and the interest to staff all the various organisations. I shall be interested to know where the Minister thinks such people will come from.
	If that sounds depressing, perhaps I may turn to something else that other noble Lords have mentioned that also depresses me--the distinction between what are described as nursing services, which will be free of charge to the patient, and personal care services, which will not. I shall not dwell on the issue, because others have talked about it before me and no doubt others far more knowledgeable than I will speak later in the debate. I cannot see how it will be possible to make a clear distinction in many cases. It is not easy to make a clear distinction in normal conversational terms, let alone in the precise terms that will be required to implement a system in which there is payment on one side and no payment on the other. This is one of the most worrying issues in the Bill.
	At first sight, the provision seems like a good idea and a step in the right direction, but I foresee all kinds of anomalies and real senses of injustice, when people feel that they are being nursed but the authority's view is that they are receiving personal care, for which they will have to pay. I see no way out of the dilemma, given the set-up in the Bill.
	Even worse, that which is described as nursing care can be given only by a registered nurse. We know that in practice, particularly in residential or nursing homes, care may be delivered by those who are not registered nurses--they may be known as healthcare assistants or by some other title. On what possible basis of justice or fairness can one ask people to pay simply because the person delivering the service does not fall into a particular category? That is a very serious defect in the Bill and I see no way out of it without radical changes.
	There are also potential perverse effects. Care assistants may not be used as much, because people may then have to pay. Where will the additional nurses come from to undertake such work when they are already in desperately short supply in our main hospitals? We do not have a wonderful fund of nurses waiting to be employed. Again, I foresee real difficulties.
	I wish that I could give a greater welcome to the Bill. I have dwelt on the issues that worry me, not on those that are wise and good steps in the right direction. I have described enough to make me very concerned about a number of aspects of the Bill.

Lord Rea: My Lords, I thank my noble friend the Minister for his clear and characteristically enthusiastic explanation of the varied purposes of the Bill. As he said, some of the clauses do not relate directly to the NHS Plan and have been tagged on, perhaps to save creating additional small Bills. I am referring in particular to the abolition of the Medical Practices Committee, which was not presaged in the NHS Plan, and the disclosure of patient information, which is dealt with in Clause 67.
	I shall discuss four clauses: Clause 18 and associated clauses, which abolish community health councils; Clause 21, which concerns the abolition of the Medical Practices Committee; Clause 33, which details the terms and conditions for doctors providing personal medical services; and Clause 67, which we have discussed many times already in the debate. There are many other clauses worthy of discussion, but other noble Lords have already dealt with them, particularly those relating to care trusts and social care. I hope that other noble Lords will talk about pharmaceutical services.
	Clauses 7 to 19 deal with the abolition of the community health councils and the creation of their successor bodies. At the outset, before discussing these, will my noble friend the Minister comment on the proposed timing? Can we be assured that the new organisations will be up and running before the community health councils are abolished? If, as I hope, many of the community health councils' paid and voluntary staff are transferred to one or other of the new bodies, can they continue to function under the aegis of the CHCs while the new arrangements are being brought into being? How are the phasing out and phasing in to be managed so that the experience of the CHCs' staff and volunteers is not lost?
	My noble friend will agree that the abolition of the CHCs was not properly discussed or consulted on before the NHS Plan was published. Of the 25 bodies whose leaders signed their approval of the NHS Plan on pages 6 and 7, at least two to my knowledge--and probably more--have said that they oppose the abolition of CHCs. Significantly, no representative of the Association of Community Health Councils for England and Wales was asked to sign the plan.
	Some welcome changes have been made in another place, as other noble Lords have mentioned, but the net effect is still to remove the community health councils, which are the only reliably independent watchdog of NHS services, and replace them with a variety of other structures, not all of which are on the face of the Bill, which means that they will not have statutory powers. PALS, which the noble Baroness, Lady Fookes, was just talking about, is one example,
	It is good that the independent advocacy service is to be set up, under Clause 17, but I have a problem with the wording of subsection (1), which says:
	"It is the duty of the Secretary of State to arrange, to such extent as he considers necessary to meet all reasonable requirements, for the provision of independent advocacy services".
	Let us suppose that some future Secretary of State does not consider such services necessary, or gives them a lower priority than do the present Government. The Bill leaves too much leeway and might allow an inadequate service. In addition, there is no mention of funding.
	It is a pity that the local authority overview and scrutiny committees, which could well have a useful role, will not have the right to inspect premises. That will be the role of the patient fora--I am sorry, but I am going to continue to use that word. I got my school certificate in Latin approximately 50 years ago--actually, a little longer than that--and it grates to have to say "forums". It is planned that those bodies will take over the monitoring functions of the CHCs. There is no indication that the overview and scrutiny committees and the fora will work in a co-ordinated way. The fora are to be set up by the Secretary of State for each NHS trust, but I fear that they will be seen to be creatures of the trust rather than as having an independent status. The funding of the local authority scrutiny committees and the fora is left in the air. If the funding is not adequate, their functions will be seriously affected.
	Like many others, I have not been convinced that Clause 18, which covers the abolition of the CHCs, and the other clauses which set up the successor bodies provide the right way to strengthen the voice of the patient. As many other noble Lords have mentioned, I believe that reformed and strengthened CHCs--even renamed CHCs--could have carried out all the functions of the new bodies that are to be set up if they had been given more funding, and that means more teeth.
	The great advantage of that would be the retention of the independent scrutiny of the NHS that we now have. It would provide a better guarantee that patients' problems would be taken seriously if a "beefed-up" CHC, which is a statutory independent body, were able to have, for example, a counter or desk in every NHS trust, as is now proposed for the PALS. The cost would be the same. They might even be called "PALS", and in this case that would be in the true sense of the word. However, as the noble Baroness, Lady Fookes, mentioned, the name may act as a deterrent.
	I turn from CHCs to Clause 21. Among others, the BMA is concerned that the abolition of the Medical Practices Committee and the handing of its functions to health authorities, as the noble Lord, Lord Clement-Jones, described fully, will jeopardise the even spread of GPs throughout the country. That is by no means perfect yet; deprived areas are still under-served.
	However, the work of the MPC has ensured that equality of national coverage has greatly improved during the 52 years of the NHS. A fear exists that if decisions about GP appointments are left to health authorities, local rather than national priorities may take precedence. And there is a danger that the wealth of knowledge, experience, and data concerning the GP workforce that is held by the secretariat of the MPC will be lost.
	Can my noble friend say what successor body will fulfil that national function? Would it not be appropriate if the staff and data of the existing MPC secretariat were preserved in some form, possibly inside the Department of Health, so that it may continue to act as a national co-ordinating body? I shall quote briefly the British Medical Association's views:
	"The MPC has been remarkably successful since 1948 in redistributing the GP workforce ensuring a levelling of average GP list sizes between areas of deprivation which had fewer GPs and the more affluent areas. There are still problems in some areas but these should be addressed by enhancing the role of, rather than abolishing, a national body which in substantial measure has proven success".
	The BMA also asked me to mention Clause 33, which covers the lists of doctors who will undertake personal medical services. For other GPs who provide general medical services, the NHS Act states that the Secretary of State must consult,
	"such organisations as he thinks fit",
	before making any regulations. In practice, that means the General Practice Committee of the BMA. However, that is not mentioned in Clause 33, which concerns the terms of employment of the personal medical service practitioners. It seems perverse that the NHS Plan--which states in paragraph 8.9 that it is,
	"to create a single contractual framework for both GMS and PMS doctors"--
	does not negotiate with a single body for all GPs in the NHS. I hope that this matter can be sorted out through direct discussions between the department and the BMA. If not, it may be necessary to return to the matter in Committee.
	Finally, with regard to Clause 67, anxiety has been expressed from two opposing directions: those who are afraid that the clause gives the department too much leeway to reveal confidential patient information, and those who fear that by over-protecting patient confidentiality, vital data for compiling the data bases that have been mentioned, such as the cancer register and other disease registers used in important research, will be lost.
	I believe that the means exist to satisfy both parties, provided sufficient safeguards are built in. Amendments to achieve that are being prepared by the BMA and the GMC. They involve, for example, putting on the face of the Bill precise criteria which would allow the disclosure of information. I had intended to say more on that point, but I see that time is marching on. My noble friend Lord Turnberg may well discuss this issue in a little more detail and clarity than I have done.
	I hope that we can reach a satisfactory conclusion by mutual agreement because this is essentially a non-party matter. My own position is that the ability to create and maintain disease registers must not be lost, particularly the cancer register, which is a vital tool necessary to improve our not very wonderful cancer record.

Baroness Barker: My Lords, I very much welcome the debate because it offers Members of your Lordships' House the first real opportunity to go behind the headlines and spin and to work out what the real future of health and social care will be. Recent debates in your Lordships' House on particular elements of this Bill, such as the abolition of CHCs and the refusal to fund personal care, have demonstrated widespread misgivings from all sides about the Government's proposals.
	Part of the problem stems from the huge range of issues included in the Bill, many of which were not fully examined as it was fast-tracked through another place. This ambitious Bill attempts to do two things: first, to produce a response to the macro-economic issues of an ageing society; and, secondly, to bring about a detailed restructuring of health and social care.
	Inevitably, at the heart of such endeavour lies the issue of resources. Although Members of your Lordships' House hold different views on the extent to which health and social care should be funded from taxation or private insurance, it is to be hoped that during our debate agreement can be reached about the basic levels of care which individuals can expect and about such principles as accountability, which should underpin the delivery of care.
	When I was preparing for this debate, I turned to the source documents: the Sutherland report and the NHS Plan. On re-reading the latter, I was struck by the way in which the document is bold and descriptive about the NHS. However, it is short on both detail and resources when it comes to community services and virtually silent on voluntary and community services. If one follows the Minister's analogy of the NHS Plan as a map--the British Isles, I presume--the voluntary sector appears to be Rockall. That is a big flaw to which I hope to return.
	In recent weeks, the BMA and the RCN have expressed very deep scepticism about the extent to which it will be possible to achieve the targets for increasing the numbers of doctors and nurses as funded by the amounts specified in the plan. That being so, those of us whose interest focuses primarily on community and social services should be very worried about the Bill. Within the Bill the aim of making delivery of health and social care more efficient by restructuring contains within it a danger. The Bill will give the Secretary of State greater control over primary care budgets; additionally, it proposes the amalgamation of that part of the NHS that controls demand via waiting lists with social services departments, which are not allowed to have waiting lists and therefore tend to use assessment as a means of control. Taken together, those two provisions have the potential to reduce levels of service and to distort registration of need and demand, which is a significant concern.
	One of the main difficulties that is bound to hinder Members in their deliberation on the Bill involves those matters that are not in the legislation. Noble Lords have already said that much is contained in regulations and guidance that have not yet been published. The Minister referred to the Government's proposals for health and social care as a jigsaw. It is: trying to understand what those proposals are is like trying to do a jigsaw without having seen the picture on the box and knowing for certain that one has not got all of the pieces.
	To give just one example, I refer to the national service framework for older people. It has been announced more times than a Virgin mainline train but it is still not published. It is impossible to make sense of the Bill without that information. Should any of your Lordships consider that to be an overstatement, I invite them to consider the curious case of intermediate care. Whenever Members of this House or another place have challenged the decision not to make personal care free, Ministers and other contributors to the debate, such as the noble Lord, Lord Lipsey, have put forward the defence that £900 million will be spent on intermediate care and other related services. The intermediate care guidance came out in January. Some of your Lordships may have blinked and missed it. It appeared on the Department of Health website without even a press release. So quiet was its emergence that for several days afterwards the DoH denied that the guidance had been issued.
	Noble Lords may wonder why there is such uncharacteristic coyness on the part of the Government. A detailed reading of the guidance begins to afford an explanation. It announced an extra 500 intermediate care beds but it does not say what they are extra to. Does it include current rehab services or help-at-home hospital services? It is not clear. The guidance refers to intermediate care and related services but it does not say what those related services are. It does, however, make it clear that in order to qualify for intermediate care, people will have to meet five tightly drawn criteria, the most significant of which are that they need active therapy or treatment that will last no longer than six weeks. Many people with chronic conditions will therefore be ineligible. That hardly seems to be a substitute for free personal care.
	In addition, although the guidance talks about the appointment of intermediate care co-ordinators, there is no way of telling whether the system for delivering that care will involve a reconfiguration of existing services or an additional new tier.
	Perhaps the most obvious explanation for the Government's reticence on this subject involves funding. Paragraphs 28 to 30 of the circular detail a total of £504.7 million which has been earmarked for the NHS by 2003-04 for intermediate care and community equipment services. Paragraph 31 states that the general settlement for local government has taken account of the additional investment needed to promote independence. However, nowhere is that set out in detail, nor is there any indication that those moneys will be ring-fenced.
	Information is integral to the debate that your Lordships will wish to have on the Bill's provisions concerning personal care. I therefore ask the Minister to provide a detailed breakdown of precisely how that £900 million has been allocated across the NHS and local authorities and in relation to the range of services that it is intended to cover. I add that the simple reiteration of the guidance is not good enough. Unless the Government give full details of investment in social community services and do so with transparency, it will not be possible to accept their decision not to fund free personal care.
	Noble Lords who have spoken in this debate have already said that the current definition of nursing care in the Bill is so narrow and was heavily qualified by the Minister this evening that it cannot yet be considered to be an acceptable basis on which to build a new system of long-term care.
	In debates such as these, there is a natural tendency to focus on that which is in the Bill. I want to make two points about what is omitted from it. First, transport for health is frequently overlooked and, despite being registered as a concern by those who were involved in the consultation process on the NHS plan, is barely ever mentioned. In fact, it never gets a mention anywhere. It is not unheard of for health authorities and regional NHS executives to have nobody with named responsibility for patient transport. Nevertheless, at a time when the Government are making major structural changes to the delivery of healthcare services and when transport is increasingly difficult for everyone in society, we might have expected some joined-up government in this context. However, there is none. I hope that we shall return to that matter at some stage.
	The second omission is one in relation to which I declare an indirect interest. A huge amount of care, especially personal care, is provided informally by close family and friends acting on their own or with the assistance of voluntary organisations. That is one of the main reasons given by the authors of the minority report for not making personal care free. Many of those organisations are highly respected for their closeness to users and their capacity to do preventive work in a way that statutory organisations often cannot do. However, the Bill contains no recognition of those organisations or their need for core funding. Such funding should not be tied to output or involve short-term project moneys; it should cover essential running costs. Many organisations receive funding under Sections 64 and 65 of the Health Services and Public Health Act 1968. Year on year that money, particularly in local authorities, is dwindling. Without a similar provision in the Bill, it is highly likely that many organisations that make a valuable contribution to the mixed economy of care and partnership may well fold. With that in mind, initiatives such as Care Direct, involving, we are told, volunteers, looks less like an imaginative approach to social care in the 21st century and more like a partially thought-out attempt to take over the voluntary sector.
	While local authorities are busy voicing their justified concerns about being the junior partners in care trusts, many voluntary organisations are wondering whether they will continue to exist. If they do not, a valuable part of community care will be lost and the whole basis of the Bill would be in doubt.
	In conclusion, there is much in the Bill to support. If, at the end of our debate, it has not been possible to demonstrate that there will be adequate and transparent funding, there will not be a sustainable framework for the care of vulnerable people. At the moment, the jigsaw is incomplete. On that basis, the Government should expect some hefty challenges in the weeks to come.

Baroness Wilkins: My Lords, I thank my noble friend the Minister for his clear introduction of this Bill. I welcome in particular the extension of and requirement to provide direct payments and the move towards more integration of health and social care for those on the receiving end.
	Disabled people have long argued that the divide between health and social care can be artificial and unhelpful. But they are concerned that the current proposals for care trusts will have unwelcome outcomes. One of the biggest concerns is that the trusts may undermine the Government's progressive policies on independent living. The fear is that the care trusts will be dominated by health definitions of independence, which tend to focus on functional impairment and not on disabled people's much-prized aspirations for choice and control over their lives.
	I am indebted to Frances Hasler, co-director of the National Centre for Independent Living, for her insights on these matters and should declare that I am a member of that organisation's independent living committee. I want to address two specific concerns. Those are the continuing divide between nursing and personal care, which have been discussed so eloquently by many in your Lordships' House; and the lack of awareness of independent living and user involvement issues in the health sector. Those concerns have arisen because the Bill gives the lead on assessing and commissioning long-term care services to new health bodies, with weak input from the local authority side or from user representatives. It had been hoped that any change would be based on a new form of authority, incorporating the best of both health and local authority practice.
	For disabled people living independently in the community, it seems only sensible to bring different providers closer together. Recent research by the University of Manchester clearly demonstrates that disabled people do not divide up the list of their everyday needs into health, social and domestic categories, unless forced to do so for assessment reasons. As one user said, "In my mind you can't split personal care into separate compartments ... It's the wellbeing of the whole person".
	From that perspective, it makes sense to combine the commissioning and delivery of the services. But the same study and others like it also vividly illustrate why people prefer to use social services, and in particular why they use direct payments which give them choice and control. They have no control over care from health workers. Disabled people report waiting and waiting to get up. As one person said, "I can't make plans in the morning because the nurses come anytime between eight and eleven". Others have been patronised and bullied to go to bed early. As one said, "I've had nurses come in here at half past nine in the evening, say, 'Come, come, Mrs Jones, it's late enough'".
	The delivery of health services is based on clinical need. Social need, such as those two people wanting to control the times they get up and go to bed, comes a long way down the agenda. It is hardly surprising then that disabled people find health practitioners are not aware of social need and are unaware of independent living.
	The National Centre for Independent Living carried out some research into the knowledge about and support for independent living in health authorities and trusts and in social services. Not surprisingly, it found that there is far greater knowledge in social services authorities. More worryingly, it found a complete indifference to the subject in some health bodies. So there is trepidation that those bodies might soon be responsible for assessing, commissioning or delivering services for disabled people who want to live independently.
	NCIL shares the concern of the Local Government Association--highlighted by my noble friend Lord Smith of Leigh who is not now in his place--that care trusts, as NHS bodies, may leave councils as the junior partner. That could have major implications for the quality of care provided, as a community-based service--focused on supporting people in their own homes and communities--is brought into a service dominated by the treatment of ill health.
	If care trusts are to be true joint partners between health and local authorities, they should have fundamentally different governance and management arrangements to PCTs and NHS trusts. They should have an equal balance of input from local authorities and the health service and a robust user involvement.
	The other problem I want to highlight is the contradiction inherent in dividing up nursing and personal care, if I may add to the concerns already voiced by many in this debate. The help which people arrange by direct payments can include many tasks traditionally thought of as "health" care; daily human assistance to sit up, get washed, move about, communicate, take medicine or use the toilet. It can cover ventilator care, stoma care, foot care and physiotherapy exercises.
	This Bill makes nursing care--that which is delivered by a nurse--free. But it leaves "personal care", including all the activities just mentioned, to be charged for. The logic of that escapes most disabled people, as it does many in your Lordships' House. For example, if you need chest suction in order to breathe properly, the nature of the task does not change, whether a qualified nurse or an unqualified personal assistant carries it out.
	The arbitrary division between nursing and personal care undermines one of the aims of the Bill, which is to make services more coherent and efficient; seamless care. So one body can assess your need, one body can arrange your services and, quite possibly, one person can provide the service. But then an arbitrary amount of that service will be deemed to be social care and you may well find yourself charged for it.
	We know that inequities will persist. At present in west London one health authority regards all ventilator users as clearly in health need and so contributes financially to their independent living packages. A nearby authority takes a different view, arguing that if people are being successfully maintained without health worker intervention, their need is clearly social, so contributes nothing.
	It is the Government's intention to keep charging for personal care, and Section 7 guidance on this is out for consultation at present. But charging will greatly weaken the potential for joint work and pooled budgets--the aims of the Bill. It will introduce unnecessary bureaucracy to care trusts and cause huge confusion to users.
	To conclude, perhaps I may ask my noble friend the Minister how the Government plan to ensure that the establishment of care trusts will be a true joint partnership. How can they ensure that they will not be dominated by health ideology and concerns and so undermine the excellent work which the Government have done to promote choice and control in independent living for disabled people? Most importantly, perhaps I may add my plea to that so eloquently voiced by so many other noble Lords tonight urging the Minister to reconsider the damaging divide between nursing and personal care.

Baroness Greengross: My Lords, perhaps I may start by saying how much I welcome the Bill, the philosophy underlying it and its aims to provide more co-ordinated, joined up or seamless care.
	My main remarks will be on Part 4 and I shall touch on Parts 1 and 2. I start with the issue of successor bodies to community health councils. It is essential that they have real powers to ensure equity of access. To do that they must be able to tackle implicit as well as explicit age discrimination, which is not usually recognised. It certainly is not policy but it happens. Will the new bodies be strong enough to do that?
	In Clause 12 it seems that some of their powers were permissive rather than mandatory. We must make certain that those bodies can ensure ease of access and that they are seen as an integral part of an individual's care pathway. If so, they will succeed, but it is important that they have enough powers to do that.
	I turn to care trusts in Part 3, Clause 52. That could be a welcome development but it is unclear how it fits in with the new joint working arrangements that have only just been implemented last year. We must protect vulnerable people from changes which could gradually eat into NHS care. Although I understand very much the fears of local government at being turned into the junior partners of health professionals, I am even more concerned at the threat to people who provide essential services such as home help, which have always been Cinderella services but back up effective community care. Community care is essential. It needs to take into account the situation of the whole family, especially if a frail person, particularly an elderly person, is a carer of a husband or wife. There is quite a lot of rigid demarcation of duties and it seems as if there will be more.
	I heard today of one elderly couple of which one person was very frail and the other was the carer. A simple task of putting elasticated stockings on to one of them was made difficult because only one was allowed to be cared for by the carer looking after them. That lack of flexibility can be damaging, if we are not careful.
	I turn to Part 4 and preserved rights, in Clauses 57 to 59. Their abolition is welcome, but why cannot this occur at the same time as free nursing care is due to be implemented? I seek reassurance from the Minister that, in the meantime, until April, new regulations, which are due at any time now, will include all people with preserved rights who are threatened with eviction, either from a nursing home or a residential establishment. There was recently an awful case quoted on "You and Yours" in which a 102 year-old lady was very worried about being evicted and having no money left for her funeral. I am sure the Minister agrees that such cases cannot be tolerated.
	I turn to contractual arrangements, which are dealt with in Clause 60. This is a very welcome provision, but I question the position of people who perhaps have a little over £16,000--which will later be £18,500--and must themselves negotiate with care home owners. Often, if not always, they need the involvement of social services to assess their needs, because under a social services contract they know that their care is being monitored and they can complain if necessary. At the moment it appears that people who have that amount of money will be discriminated against. I hope that the Minister can reassure us on that matter.
	I turn to liable relatives. In the recent survey by Age Concern, All My Worldly Goods, it was found that there were huge variations in local authority practice in the treatment of spouses and the use of discretionary powers to disregard the value of the home. I understand that in another place the Government promised, through an appropriate amendment, to end the liable relative rules. I am very disappointed that that amendment was not tabled, and I hope that the Minister can update your Lordships' House on the Government's position in that regard.
	I turn to Clause 56 and the very vexed issue of nursing and personal care. I made clear my position in the debate last month initiated by the noble Lord, Lord Ashley. I very much welcome free nursing care. The limits of nursing care and the exclusion of certain essential services, which most people would define as "nursing care"--perhaps contrary to some views expressed by the Government--seem to have caused a good deal of worry and anxiety. The NHS Plan published in July of last year contained the implication that a wider definition of "nursing care" would be accepted. The statement that,
	"in future the NHS will meet the costs of registered nurse time spent on providing, delegating or supervising care in any setting",
	seems to make that clear. Now it seems that the care itself will not be free, only the time spent by the nurse arranging, delegating or supervising.
	I spent many years as the chief executive of a fairly large organisation. To me, "delegation" meant retaining responsibility for what was being done while the work itself was carried out by someone else. I was not the only person to believe that the nursing definition would be broad enough to cover certain essential services in a very clear way. The noble Baroness, Lady Wilkins, mentioned some of those matters. For example, the use of gastro-nasal tubes and the provision of pressure sore beds, which may be an enormous cost to an individual, can be, and sometimes are, charged for. If that is done through a nursing home a broad, across-the-board charge would be made for that equipment. It is very difficult to see how that can be justified. I believe that a definition should be inserted into the Bill, and I hope that noble Lords will seek to amend it accordingly.
	I am very much aware, however, that the Government are unlikely to change their mind on free personal care despite the views that have been very eloquently expressed today and in another place and by many organisations and representative bodies. I believe that we are in danger of victimising people who are very frail, particularly those who remain in their own homes, many of whom suffer from dementia.
	It is also important to remember that care home fees are high. Even with free personal care, should it be introduced, some people will have to find £200 or more a week for their board and lodging. It seems that the charging policy for nursing and/or personal care will vary as people's needs change. So if one's needs for nursing care are higher at one stage, it will cost one much less than if one's needs change and are defined as personal care. I believe that there are dangers in that system. We know that whatever is covered in the board and lodging charges, which in the London area can exceed £500 per week, it still means that there is a great deal left to be paid for.
	So the definition of "nursing care" needs to be carefully broadened, otherwise it looks like a tax on disability, particularly chronic disability, which penalises the most frail regardless of his or her means. Perhaps the answer might have been to define those quintessentially essential services as "nursing care". In my view they should have been defined as "nursing care" or, at least, "para-nursing care" rather than "personal care". If that had happened I suspect that this part of the debate could have been avoided. I hope that the Minister will reassure me that some compromise on this issue might still be possible.

Baroness Hanham: My Lords, as I rise to speak, may I initially declare my interests as chairman of a London National Health Service trust and as a member of a local authority.
	The Bill has in many respects been well received. However, as always, and as has been said, the devil will lie in the detail, much of which is, as so often happens, being left to regulation and perhaps secondary legislation. Today, in consequence, I have three particular areas of detail to which I want to address my remarks and to pose questions to the Minister.
	The first of these areas relates to the implementation of the proposals for patients' forums, particularly as regards those that relate to a hospital trust and the intention that one of its number should be appointed as a non-executive member of its host trust board. As Members of this House will know, directors of trusts are currently appointed by the Secretary of State on the recommendation of the regional chairman. In future that role will pass to the national appointments commission. Directors have varied responsibilities to the Secretary of State for the financial viability, management and compliance with statutory requirements and government priorities.
	Of course no hospital would exist if there were not patients who required treatment and care. They are an integral aspect of the board's responsibilities. Indeed, my trust already holds two charter marks for its patients liaison arrangements. However, decisions and priorities regarding service constantly have to be made. Up to now they have been made by all the non-executive members of the board, each of whose responsibility and commitment is to that trust board. Within the delegated functions of that board, individual non-executives assume responsibility, for example, for overseeing finance, audit, clinical governance and patients' complaints. But none has any form of promotional or pressure lobby role for any of those individual functions.
	Under the Bill, patients forums will have the right to inspect the premises of the hospital to which they are attached. They will be required to monitor and review the services for which the trust is responsible, represent patients' views and give advice to the trust about matters relating to its services. One has to question whether a member of that forum, appointed to the trust as a functioning director, will be able to maintain the independence necessary to see these matters are brought to the board, while inevitably having to be responsible with other board members for matters which may very well impinge on or override the views of the forum. How does the Minister envisage that such a role will be possible? Does he not have any qualms that the independent voice of the patient, which is surely the rationale behind this proposal, could be crushed and not come through with the clarity necessary? Does he really believe that a person put in such a position could wear the two hats and not be compromised or not become disengaged from the full work of the board as a result of the competing priorities? Perhaps it would be more sensible for the patients' forum representative to have a right to sit with the board--I have no difficulty about such a representative being there--but to be unencumbered by other non-executive responsibilities.
	Arising from this, if the Minister is not prepared to give way to my pleas on that aspect, I want to ask about the appointment of such members. I understand that this is still a reserved matter. However, the Bill says that the make-up of forums will be of patients of the trust and unstated voluntary organisations. Is it the intention that all members of the forums will be assessed for suitability by the National Appointments Commission? If not, and the Government proceed with their intention to see one member appointed as a non-executive director, will it be the intention that the member selected will then be assessed and appointed by the commission? All non-executive directors of trusts, as I have already said, have to be appointed by the Secretary of State. It would surely be anomalous if that was not the position in all cases and such appointments were just left to the forum to make as its own choice.
	Finally, as regards this matter, will the forum non-executive director be in addition to the other five--in which case, previous legislation will presumably have to be amended--or is it the intention that one of the current members of the board will have to resign in order for the forum's nominee to take his or her place? My own view is that that would be unacceptable. The Government's intentions have not, I believe, been made clear in these important matters. I hope that the Minister will be able to throw some light on them today.
	I turn now to concerns that have been expressed to me about the provisions in the Bill regarding preserved rights and the changes to the funding of care, which has until now been undertaken by the DSS, for those who have been in long-term residential care since before previous reforms took place in 1993. They have been dealt with competently by other noble Lords, but I wish to make one or two additional points. Those involved since before 1993 in the main will now be quite elderly or those with learning disabilities, now mostly adults, who were placed in homes--often those provided and supported by charities. The Bill passes responsibility for their continuing financial support from the DSS to local councils. Whether this will be to the "host" authority--since many such homes will not be in the area from which the residents originate--or to the originating authority is not, I think, yet clear.
	How will authorities obtain details of those for whom they will assume responsibility? Will the money to be transferred to those authorities be equal to the amount that is currently provided by the DSS? Will authorities be required to make bids; and how will the funding be identified and uprated in the future--will it be through the SSA or will be it be ring-fenced?
	There are great fears among the parents and relations of people in residential care that local authorities will find that the money they receive is inadequate and that they will be tempted to break up such residential homes by repatriating and providing "community care" for those who have been in supported care for much of their lives. Will this not go against the whole principle of the Emerson report, which found that residential homes could provide good and varied care, giving valuable support and security to their residents who have made friends and formed relationships within them? They might find it very difficult to be uprooted from them and transferred to a strange community care environment. There is deep unease at these proposals and some reassurances need to be given to those who have loved ones or responsibilities for those in such care. Reassurance also needs to be given to local authorities about the level of funding, since it would be invidious if they were faced with making decisions which were inequitable with the desires both of those in care and their families.
	Finally and briefly, local authorities are concerned about the manner in which appointments will be made to care trusts. This point has been touched on by many noble Lords. While there is approval for the principle of such trusts and the flexibilities they will bring to the provision of services, there is an urgency to understand the Government's arrangements, in particular about the appointment of local authority representatives and the need to ensure that these trusts are a partnership of equals between the National Health Service and the local authorities.

Lord Beaumont of Whitley: My Lords, the noble and learned Lord, Lord Archer of Sandwell, commented on the way in which your Lordships' House divides itself into colleges on different subjects. It is true that one can often forecast who will speak in a particular debate. I have never belonged either to the health or the care colleges, but that I embark to speak on this complicated and important Bill is largely due to the fact that, as the only representative of my political party in this House, I am the spokesman on every single subject.
	I give general approbation and assent to the idea behind the Bill. Over a long period of time, attempts have been made to solve problems in National Health Service provision by dealing with individual difficulties affecting individual people. Procedures have become regularised and systems are rigid. The Bill seeks to move in the opposite direction and is therefore very much to be welcomed. By pulling together the notions of health and welfare, it will bring those services offered to the ordinary citizen closer to their real life situations. Contributions made by noble Lords in the course of the debate have been in favour of that aim.
	The Bill seeks to deal with people more often in their own homes, which is where they want to be. It makes provision for people to receive help from their neighbours and friends, which is also what people want. However, it seems to me that there are some provisions in the Bill which move in the wrong direction and against that tendency. Those are matters to which we must pay attention in what will quite clearly be some rather long stages of the Bill.
	We are moving into an area which will become much more complicated and difficult to deal with the longer we go on. In Florida--which, admittedly, is almost an old-people's state now--some 18.5 per cent of the population are over 65. This country will reach that stage in 2016. There will be many, many more elderly people and many, many more people needing healthcare, but there will not necessarily be a great deal more money or a great deal more manpower unless we think imaginatively about what should happen. The suggestions of some noble Lords have been very imaginative and move in that direction.
	When we come to the issue later in the Bill, I shall want to talk about community health councils, as will many other noble Lords. The bodies which will be produced as half-substitutes for community health councils are many things, but they are not community. It is very important that the element of community should be kept. I hope that the Government can be persuaded to think again on that subject.
	Over the next 50 years, all governments of this country will have to think imaginatively about the question of funding. We may not necessarily have to deal with everything in the monetary terms that we have used in the past. Your Lordships may know--I hope that the Government do know--about some of the experiments being carried out around the world. In Japan, where there is already a very high elderly population, a pilot organisation has put forward an alternative monetary system called "caring relationship tickets". In addition to ordinary health insurance, which continues in the usual way, this is a system whereby people have tickets for an hour's worth of help of one kind or another, which they can use or exchange when they are organising health care between various people who are already known to them. It is a community effort and well worth exploration in the future.
	We will obviously have to deal with a large number of matters over the coming months. Basically, it is a good Bill. I do not see how we will manage to get through it without keeping rather elderly people up later than would be advised by almost anyone we are talking about in the debate. I hope that the Government will manage to keep it under control and that we will manage to persuade the Government to loosen up the Bill a little more, because that is the direction in which it needs to move. I wish it well.

Lord Turnberg: My Lords, I welcome the general thrust of the Bill. There is much in it which I regard as essential and valuable; it follows well on the NHS Plan. I believe, for example, that the proposals for patient forums and patient councils will go a long way to compensate for the loss of CHCs and will provide an even more valuable opportunity for patients and the public to have their views heard and acted upon. The extension of prescribing rights to a number of healthcare workers, with certain controls, is entirely appropriate.
	Noble Lords have spoken eloquently about other important aspects of the Bill. I should like to say a little more about Clause 67, dealing with the use of information derived from patients and the role that the Secretary of State will have in controlling access to that information. I do so with some trepidation. This section of the Bill is written in language which, to me at least, is somewhat obscure. I am sure that that is due entirely to my own inadequacies.
	Much of what is proposed is heavily dependent on what will appear in regulations yet to be written. Therefore, I am particularly keen to have some reassurance from my noble friend the Minister regarding the contents of the regulations and how they will be enacted. I found his letter, which he kindly circulated, very helpful but not entirely so.
	There appear to be two main elements to the clause. The first makes it a punishable offence for anyone using information derived directly or indirectly from patients for commercial purposes. That is true whether or not the patients from whom the data has been obtained can be identified. The pharmaceutical industry has expressed the concern that its use of "anonymised" data, which cannot be conceived as harming individual patients, will be prohibited, thereby damaging the industry and thus the NHS.
	I have a different concern. What is not absolutely clear from subsection (2) is whether data relating to individuals who cannot be identified or traced can be used for non-commercial reasons--for example, for research or for monitoring the incidence of disease in the population. The distinction between data from patients who can be identified and those who cannot is not absolutely clear. I hope that my noble friend will reassure us that so-called anonymised data which cannot be traced to individual patients and which, therefore, cannot possibly pose any harm or embarrassment to them, can continue to be used at least for research.
	The second element of the clause provides the Secretary of State with the opportunity to approve the use of information derived from patients, whether they are identifiable or not, given certain safeguards and procedures. The GMC and the Royal College of General Practitioners have expressed anxieties that this could lead to a betrayal of trust between patients and doctors. I fully understand their concerns. After all, I know full well that effective medical practice is heavily dependent on patients believing that the private and privileged information that they give to their doctors will be treated as strictly confidential. So I am strongly in favour of the idea that careful control should be placed on the use of such confidential information. But I am afraid that I cannot agree with the idea of the GMC when it seeks to prohibit the use of patient information even where it is clear that patients and society can gain from so doing, and where harm may actually result from not so doing. I shall mention one or two examples shortly.
	I therefore support the presence of subsection (3) in Clause 67, which gives those powers, under certain conditions and subject to certain safeguards, to the Secretary of State. But I have other concerns. First, it would appear that without the Secretary of State's approval no data derived from patients can be used for research. Unless I am mistaken, that seems to be the case even if the data are anonymised and thus no patient can possibly be harmed.
	Perhaps I may give one or two examples. If researchers wished to examine the hypothesis that certain forms of cancer may occur more commonly than one would expect by chance in people living near, say, radio aerials or electricity pylons, or in mobile phone users, they would not be able to do so without the Secretary of State's approval. If Sir Richard Doll wished now to carry out his ground-breaking study, which revealed the relationship between smoking and lung cancer, he would need to seek the agreement of Mr Milburn. Further, if I understand the proposal correctly, he would have to seek agreement for every year that that study required.
	I hope that I am wrong in my understanding of the proposals--indeed, I should be delighted to hear that that is the case--or, alternatively, that the regulations will make it clear that such a bureaucratic system can be changed before it is too late so that such research is not frustrated. However, there is another more pressing type of problem where, unlike the one that I have outlined for research, the impact will be felt in the future when new treatments or cures may be delayed, the health of the population may be damaged more immediately. This is to be found in the measures that are necessary to prevent the spread of infectious disease, where it is important to know who the persons are who have the infection. I should express an interest here because I am chairman of the board of the Public Health Laboratory Service of the Department of Health, whose responsibility it is to protect the public from communicable disease.
	For the PHLS to fulfil this role it requires pathology laboratories to report to it the occurrence of infections, such as E.coli 0157, food poisoning, meningitis, hepatitis and TB. We are then in a position to set in rapid action all the activities necessary to trace the source of the outbreak and, where possible, to remove it. Of course, we do not do that alone. Local environmental health officers, consultants in communicable disease control and medical practitioners are all involved and need to know that the infection has occurred and who has it.
	Some of those infections are notifiable; that is, doctors have a legal duty to report them, irrespective of patient confidentiality. But the problem is that many infections are not notifiable. The most obvious examples are those causing food poisoning--E.coli 0157, salmonellas, campylobacter, and the like. Here speed is of the essence if the disease is to be prevented from spreading. It is not always easy or quick for a laboratory detecting one of these infections to be able to contact a GP and for the GP to contact the patient to seek his or her consent to tell the PHLS, the environmental health officer and the communicable disease control doctor. Yet we must move quickly in these cases to find the source of the outbreaks, usually the food.
	The GMC's current guidelines on confidentiality are already inhibiting laboratory personnel from reporting. In this light, the permission that may be granted by the Secretary of State under Clause 67 is very welcome. I hope that my noble friend the Minister will take on board this particular case when the regulations are formulated. However, if the process by which approval is granted--as surely it must be for such an obviously common-sense purpose--is prolonged and bureaucratic, it could pose considerable difficulties. I hope that this, too, will be taken into account in the regulations.
	In conclusion, I should say how grateful I am to the Minister and his officials for giving me the opportunity to discuss some of these concerns and for offering at least a degree of comfort on some of them. I look forward to even more comfort.

The Lord Bishop of St Albans: My Lords, it seems to me that this Bill is fundamentally about the way that we in Britain wish to care for the most vulnerable in society in the years to come. It is quite rightly centred on them. However, I should like to highlight those who I believe are among the most vulnerable. I shall begin, perhaps unexpectedly, with the staff of the NHS and social services departments throughout the country. They have been required over the past couple of decades to respond to unremitting and relentless change.
	Systems have been altered, whole armies of technicians have scuttled from hospital to hospital re-arranging the acronyms on the notepaper. I shall give your Lordships an example. It is not actually from the NHS or from social services, but it could be. I opened a page at random in the Government's document on Neighbourhood Renewal and found the following,
	"CPRPs, Neighbourhood Wardens, Drug Action Teams, Fresh Start, Education Action Zones, Excellence in Cities Programme, School Improvement Grant, Pupil Support Allowance, Study Support, Adult Basic Skills National Strategy, Sure Start".
	The only one missing was Old Uncle Tom Cobbleigh and I have little doubt that he will be included under the equal opportunities programme. In two pages there are 11 initiatives.
	I recognise that those initiatives are well intentioned. However, at the receiving end, whether in communities, hospitals, GP surgeries or social services, the net result is overload. A staff who by vocation and definition are desperate to do a good job are then demoralised and become punch drunk as the initiatives keep coming at them.
	I do not doubt the necessity for change but if change is to be effective it must move only at that pace which good human beings can sustain and it requires at the local level effective leadership and management and local ownership of the ideas sustaining change. Among the vulnerable in our society, therefore, whose plain goodwill is being exploited, and has been exploited by all governments, are the staff who have to give effect to the changes proposed in this place.
	I am sure that a dispirited and disillusioned workforce is not what any government wish. But in my experience hospital administrators, social workers, nurses, care assistants and others are grey with fatigue and aching with tiredness. That sense of demoralisation, of only existing as a human being in order to give effect to each new initiative, means that the system is close to burn out. What follows is like a smouldering bonfire; the system flares for a moment before it collapses in on itself.
	The second group of vulnerable people is, of course, the elderly. I hope that noble Lords will have seen the Age Concern national opinion poll survey of GPs' views on older people's experience of the NHS. It makes desperate reading. Some 33 per cent of doctors surveyed say that older people have an inferior standard of care in the NHS. I venture to suggest that the other 66 per cent of GPs have not been to a psycho-geriatric ward recently. Why, as a nation, do we do it? Why do we treat those who have created the wealth which we now enjoy with such contempt and disdain? We have pushed them to the outer limits of care and then we leave them there in urine soaked indignity. Now, just to make them feel even more useless, we propose to take away from them as much money as we can. We are going to do that by means of a test probably drawn from one of the novels of Franz Kafka. The test is not whether someone needs a particular kind of care but who delivers the care to someone.
	If you are taken to the loo by a registered nurse, you can go for free, if noble Lords will excuse the expression. If you are taken by a care assistant, it will cost you a small fortune. Why do we subject our elderly people to that kind of bizarre lottery? If we behaved like that as regards nursing children, the outcry would be enormous. But when we treat the elderly in such a way, except for groups such as Age Concern, the Abbeyfield Society and Methodist Homes, no one nationally seems to care.
	I digress for a moment. In a debate in this House on 17th January on the care of the elderly I threw out a challenge to the BBC. I asked: would it not be wonderful if during the next three years the BBC ran an old people in need appeal and gave to it the kind of energy and enthusiasm they give to the children in need appeal? I predicted that the BBC would respond to my challenge with absolute silence. My prediction was 100 per cent accurate--there was not a squeak.
	Changing attitudes towards the elderly is not a matter for legislation alone: it is a hearts and minds job requiring a certain kind of moral courage. I shall say no more on the subject but the implications of the silence of the media in our country about the old citizens of our country is more eloquent than any words.
	Of the most vulnerable people, the third group are those who believe that human beings have pastoral and spiritual as well as physical needs. I recognise, of course, and with gratitude that within the Bill spiritual values are implicit. But there is not a single explicit mention of the spiritual needs of patients, staff or the elderly. I am not alone--am I?--in believing that one of the factors that makes life worth living is loving and being loved. I am not alone--am I?--in believing that beauty and grace are the essence of our humanity. But where any society fails to address the spiritual needs of the vulnerable, a further slide towards treating people as objects, be they staff or patients, is inevitable.
	There is another major issue behind my concern about spiritual needs. The care and the energy that lead people to want to care for others emerge from the depths of our souls. It is within our souls that we find a well spring of love and compassion to care one for another. If as a nation we regularly deny the importance of the spiritual, shall we in a generation's time have any carers left?
	I believe that the Bill is predicated upon the fundamental assumption that human beings matter and that we are each created in the image of God. It is that most beautiful concept which should act as the canon by which we judge our actions and the legislation before us.

Lord Lipsey: My Lords, I went on holiday last week expecting that this debate would begin at four o'clock in the afternoon, with a list of six speakers. I find that the debate began at shortly after half-past six, with 25 speakers. It may be appreciated, therefore, if I truncate my remarks and apply myself to the theme of free personal care. I do not detract from the many moving speeches by noble Lords who favour making personal care free. I have been exposed to these arguments for three or four years since we started work on the Royal Commission. They are powerful, moving and strong arguments.
	However, I did not hear any of those who made that case this evening refer to the cost. They may have felt that that was a rather sordid consideration, but resources cannot be separated from policies. It is impossible to have a policy whose implications for resources do not matter. When one policy is chosen, it means that another policy cannot be pursued, whether it is a policy for the elderly, a policy for spending money on education or a policy on taxation. They all knit together into a whole. Ignoring cost means ignoring the essence of the decisions that we as legislators and politicians have to make for our country.
	Heaven knows, the proposal for free personal care put forward by the majority of the Royal Commission was expensive. It was costed at £1.3 billion at today's prices straight away, rising to five times that level by the middle of the century as the number of old people grows. Even that basic figure of £1.3 billion was a gross underestimate from day one. The right reverend Prelate the Bishop of Lichfield made a moving speech. The Royal Commission did not propose that personal care should be free to people who were living, as they should be, in their own home, with their own family at the right level of social support. It was a proposal for free personal care in residential and nursing homes only. If there was to be movement towards free personal care, that delivered to people in their own home would be my priority, which would greatly expand the initial cost.
	However, I rest my case not on the initial cost but on what will happen to that cost as we move forward. Every society in the developing world is desperately anxious about how we are to provide for our ageing population, as the number of elderly people, particularly the very elderly in need of long-term care, continues to rise. Every society is wrestling with the issue, struggling to find an answer. We cannot ignore that context.
	I shall briefly set out three reasons why the cost would be many times that estimated by the Royal Commission. First, at the moment, between two thirds and three quarters of the care that is given is informal care--the unpaid labour of relatives and friends to sustain people at home. If all personal care is free, it is inevitable that many who are struggling with informal care will decide that, although they would like to do the best for their mum, their dad or whoever they are caring for, it would be easier to take advantage of the free care available for them in a nursing or residential home. Whenever the price of something is reduced from quite a lot to nothing, there is a huge rise in demand. That may not happen in year one or year two, but it will come about as a new generation lays its plans knowing that care will be free in those settings. That will add greatly to the cost.
	Secondly, those who have studied the Royal Commission report know that it is based on an assumption of a 1 per cent real-terms rise in the money paid for social care and a 1.5 per cent real-terms rise for healthcare. That means that the wages of care workers will rise by 1 per cent a year in real terms for those in the social sector and by 1.5 per cent for those in the health sector. These people are desperately underpaid. Care assistants, who do a sensitive and important job, are paid a disgracefully low wage, very often the minimum wage. If I had a pot of money available, one of the things that I would most quickly spend it on is more training and better wages for those who are helping to look after some of the most vulnerable in our society. They cannot go on being underpaid as they are at the moment, because the quality of the people will go down as they are told day after day that their jobs are not truly valued, and the standard of the care that they give to elderly people will not go up either.
	But I am afraid that higher wages would bring a tremendous cost. The Royal Commission identified it as the single most sensitive assumption in its costings. If the increase was 2, 2½, 3 or 3½ per cent a year, the estimate of a five-fold increase would, as a result of that single factor, become a 10 or 12-fold increase over current costs.
	My third point is that I hope that we shall see a rise in standards in this field. Today, none of us would conceive of treating old people in the way in which they were treated 50 years ago. Then, they were thrown into the geriatric ward or were perhaps catered for at home by people who struggled under an impossible burden. That occurred in a society in which many women did not go out to work and were prepared to dedicate themselves to such care.
	We must have far higher standards to provide the dignity and life which our elderly people deserve. Several points have been mentioned in the debate, such as the need to talk to people with Alzheimer's disease at great length and sensitivity in order to bring out their human qualities. Those sentiments move me enormously, but they come at a tremendous price, such as the human labour time of people who I hope will be better paid.
	If one puts together those factors, the result is not an increase from £1.3 billion to five times that amount by the middle of the next century. Making the calculation on the back of an envelope, the amount will increase by between approximately 12 and 20 times the cost of introducing free personal care now. I give way to my noble and learned friend.

Lord Archer of Sandwell: My Lords, I am most grateful to my noble friend. I hope that he appreciates that many of us who intervened in this debate were quite specifically not arguing that all personal care should be free. I argued that certain forms of treatment for specified conditions should be made free, even though they may not be administered by a registered nurse.

Lord Lipsey: My Lords, I take the point made by my noble and learned friend and by the noble Baroness, Lady Greengross. In our further debates we shall come to the point regarding the precise definition of free nursing care. I am making my case against those around the House who argue for free personal care, as do many of the lobby groups in this area. It is that which I consider to be unaffordable. I am not saying that we must stick precisely with what the Government are suggesting now, because I can see the case that is being made.
	Perhaps I may develop my point as to what would happen if we adopted the proposal for free personal care. As was the case when it was put forward by the Royal Commission, that proposal has been made with the very best of motives--with the good of elderly people in mind. However, I am afraid that one of two things would occur. First, after a few years we would decide that we could not after all afford it and we would drop the idea. That can happen. It occurred in Holland, where free personal care was introduced in 1968. The cost was three times higher than had been expected and the scheme was dropped in 1982. What a cruel deceit for the hopes that had been raised by starting down that line in the first place.
	However, the other alternative is worse. One would find that this cuckoo would grow in the nest and that other items would have to be thrown out in order to accommodate it. The educational group in this House would not say, "We do not need any more money for education after all. We shall leave it all for the elderly". The transport group, meeting for another debate, would not say, "We'll drop all our extra transport needs so that all the money can go on the elderly". There would be competition for the funds.
	If the plan were not dropped, services would be jettisoned. Care workers would be made to work not more sensitively but harder, simply to get through the physical business. Care home fees, which at present are quite inadequate to enable businesses to keep up standards, would be further compressed. One would find home helps being sacked. There would be less intermediate care and less support for care in the community. In the end, a policy developed for the best of reasons--to help elderly people to achieve the dignity in their old age which they deserve--would have the worst of consequences: worse services and free care but terrible care.
	That is why, in my view, the pleas for free personal care must be rejected. I am afraid that Scotland may be undergoing a controlled experiment in this area. If that were to happen, I should feel very sad for elderly people in Scotland. They will believe that they are receiving something great. However, in the end what they receive will not be something great but a tragedy.

Baroness Carnegy of Lour: My Lords, I intervene briefly before the noble Lord concludes his speech. As someone who lives in Scotland, I have listened to his remarks with enormous interest. Would he be prepared to send his speech and any supplementary remarks to his political colleague, Susan Deacon, who is the responsible Minister in Scotland? She would be very interested in them.

Lord Lipsey: My Lords, I have been in touch with Scottish opinion. I do not think that Susan Deacon is the person to whom my words need most closely to be addressed. She appreciates the problems quite well. However, I take the spirit of the noble Baroness's point. I assure her that I shall do everything in my power to point out to the people of Scotland that if they want the policy, they may have it, but that if they obtain it, they should do so with full knowledge of the consequences of what they are entering into. If they want it, they should have it. However, I hope that they will decide at the end of the day that that is not the best thing for their country.

The Earl of Listowel: My Lords, I thank the Minister for his helpful opening speech and for his useful written briefing. I express my concern, which is shared by many noble Lords who have spoken this evening, including my noble friend Lady Masham of Ilton and the noble Lord, Lord Rea, about the abolition of community health councils. I note the welcome given to the Bill from all sides of the House. In the brief time that is available to me, I shall concentrate on one matter.
	While the current arrangements for complaints against the NHS need improvement, there is disquiet about the fact that the new arrangements will be less independent and assertive. Community health councils sometimes work well for patients. The Office for National Statistics reports that 10 per cent of five to 15-year-olds have a diagnosable mental health problem. Other research suggests that if one includes older adolescents in that statistic, the appropriate figure is closer to 20 per cent. Parents who see their child losing interest in life, obsessively washing his hands or dieting, or becoming extraordinarily excitable can wait for a year after an initial consultation for treatment to begin. Provision for child and adolescent mental health is notoriously patchy and under-resourced in the NHS. Parents who have felt helpless in the sight of their child's deteriorating behaviour have found community health councils on occasion to be tough and effective advocates on their behalf. We need strong reassurance from the Minister that the new arrangements will be at least as aggressive or effective as the best community health councils in ensuring that patients have access to necessary services.
	I look forward to hearing the Minister's response to some specific concerns; namely: that the proposed new bodies do not have the same powers that community health councils have in statute; that by seeking to abolish community health councils with immediate effect, the Bill mitigates against the smooth transition of skills and experience from one structure to another, which will be to the detriment of patients; that the Bill seeks to abolish the Association of Community Health Councils for England and Wales but puts no national body in its place--a concern allied to that expressed by the noble Lord, Lord Rea; and that the Bill leaves far too much detail to the discretion of the Secretary of State.

Lord Harris of Haringey: My Lords, I declare an interest as a former director of the Association of Community Health Councils for England and Wales and as a current member of the Greater London Assembly, of the London ambulance trust board and of the executive of the Local Government Association.
	I begin by making it clear that I am a keen supporter of the Bill. The NHS Plan has been widely welcomed in the House. It is appropriate that at the earliest opportunity the Government should seek to give legislative backing to their modernisation of the NHS. There are many matters in the Bill that I would like to raise, but your Lordships will be relieved to learn that I shall discuss only three--that may be three too many--in this speech: the arrangements for care trusts, the extension of the local authority scrutiny role to the NHS and the proposals to reconstitute the system of patient representation in the NHS.
	I, of course, fully support the ambitions set out in the NHS Plan for more integrated health and social care. Service users want their care to be seamless. They are not interested in what to them are the artificial boundaries that exist between the health services and local authority social care services. And there is no doubt that care trusts could be an important way to deliver more seamless care to service users based on voluntary partnerships between health and local government. However, like others, I am concerned that as NHS bodies, care trusts will not reflect the strengths of both partners--the NHS and local government--and it is important that the governance arrangements for the new voluntary care trusts truly reflect the joint nature of the new bodies.
	Those arrangements must be based on a partnership of equals. Yet the Bill makes it clear that voluntary care trusts will be NHS bodies and that implies that local councils and the social care for which they are responsible may be left as the junior partner. The need to ensure that the new bodies draw on the expertise of both local government and the NHS is demonstrated by recent research on the experience in Northern Ireland where health and social care have been merged for some time. That suggests that resources are disproportionately tied up in acute care at the expense of adequately developed services in the community.
	That research also shows that the location of social care within a health bureaucracy results in the domination of the medical model of needs assessment, marginalising the consideration of other needs such as those associated with social care, housing and deprivation. That makes it imperative that the governance arrangements for care trusts reflect the need for an equal partnership, and that care trusts should have fundamentally different governance and management arrangements to PCTs and NHS trusts with elected local authority members retaining a clear accountability line back to the local authority.
	Indeed, it is essential that local authority members sitting on the care trust board are selected by the local authority and are clearly seen to be representing that local authority. It is inappropriate that the new Independent Appointments Commission should be given the task of substituting its selection of elected members for those that are democratically chosen by the local authority in question. The councillors' elected status should be the crucial determinant in such matters, otherwise, we could have the absurdity of the commission appointing Labour elected members to sit on a care trust board serving an area with a predominantly Conservative local authority; or perhaps vice versa.
	I should now like to turn to the new scrutiny arrangements. I am particularly pleased to see that the Bill envisages the extension of the local authority scrutiny role to the health service. This further strengthens the councils' roles as community leaders and their existing responsibility to promote the health and wellbeing of local people. My view is that that process will work even better if there is an obligation on local councils to take note of reports submitted to them by patient forums and patient councils in carrying out their scrutiny work.
	However, the arrangements for London do not seem to be quite right. I would normally assume that the civil servants responsible for drafting the Bill had merely forgotten--yet again--London's specific needs. Yet this cannot be the case. Clause 10 devotes 19 lines to the specific problem of what will be the Common Council of the City of London. It would therefore seem that the omission of the London Assembly and the Greater London Authority from Clause 7(2) is a deliberate snub. Yet the London Assembly was set up as an exclusively scrutiny-oriented body.
	It seems bizarre that the new arrangements for looking at the operation of the NHS in general across London, and in particular the operation of London-wide services, should not explicitly be provided for in this Bill. That potentially has enormous implications for, to take one example, the chief executive of the London Ambulance Service who will, as things stand, be required to attend 66 scrutiny meetings per year. That is two sessions with each of 32 boroughs and the common council. That would be more than one a week. If the GLA had the scrutiny function, it would not only be more appropriate, but also more efficient. I have no doubt that my noble friend the Minister will reassure us that that will be remedied by a government amendment in Committee.
	At the heart of the Bill are proposals to place patients at the centre of the new NHS. It thus seems somewhat anomalous that the Bill would abolish community health councils. Last October I introduced a short debate in an Unstarred Question on this matter. At that time I expressed concern that the new arrangements would not be seen as genuinely independent of local NHS structures and that robust mechanisms are needed to be in place to ensure that various strands of work are integrated together effectively.
	I am pleased that in the intervening few months the Government have listened and responded. The Bill as it emerged from another place will still abolish community health councils. However, the proposals coming forward are now very different from what was previously envisaged. Patients' forums will now be statutorily independent bodies. The issue of co-ordination and integration of work can now at least partially be addressed by the formation of patients' councils to co-ordinate the work of patients' forums and the Bill ensures that the Secretary of State will make provision for independent advocacy services.
	That follows from the new clauses introduced in another place by my honourable friend David Hinchliffe. In doing so he made clear that they would need to be developed and built upon in your Lordships' House when he said that he makes no bones about the fact that he is proposing a framework that needs to be examined in more detail and that the amendments should be considered in your Lordships' House. It is encouraging that the Government were happy to accept David Hinchliffe's amendments, but they, together with your Lordships, now have a duty to get the details right.
	Perhaps I may deal, therefore, with advocacy and independence. Ministers still seem to be confusing the role of independent advocacy and the customer relations and support provided by the new PALS service. As recently as last month, a paper issued by the NHS Executive stated that PALS should act as a gateway for people who wish to access an independent advocacy service. Complainants who have had a bad experience will be put off returning to the trust premises to access it; the very problem that the proposed access to independent advocacy is designed to avoid.
	The Bill as currently drafted places a duty on the Secretary of State to arrange the provision of independent advocacy services as he considers necessary to meet all reasonable requirements. However, there are no guarantees about the funding, commissioning or provision of these services. It is essential that that be clarified on the face of the Bill. I would argue that patients' councils should provide those services, not only because they will be--I hope--truly independent of the trust concerned, but also because it will permit the councils to integrate the lessons learnt from their advocacy cases into their wider work, one of the strengths of the better CHCs in the existing system.
	I am also concerned that there is too much discretion given to the Secretary of State in Clause 17 as to whether or not to arrange these services. Indeed, the only safeguard of independence provides that:
	"services ... should, so far as is practicable, be independent of any person who is the subject of a relevant complaint or who is involved in investigating or adjudicating on such a complaint".
	In other words, they do not have to be independent of bodies about which complaints may be made, only of the individuals who are complained of.
	Patients forums and councils are intended to be independent, as are the advocacy services. However, in the Bill there is uncertainty about where their staff and secretariat support would be based, with the Department of Health suggesting that there is a strong case for them to be based with local authorities. A link with local authorities has many attractions. It would certainly improve integration with the scrutiny process. However, in my view a more logical approach would be to make the proposed national patients organisation responsible for the staffing and budgets of local patients' councils and forums.
	The existing arrangements for the accountability framework and staffing and budget systems for CHCs are a mess. It would be a mistake to create something equally unsatisfactory. If I remember correctly, staff are notionally employed by a health authority, have pay and rations organised by an NHS trust, but are accountable and line managed by the NHS regional office. CHCs themselves are in practice either accountable to no one or to the NHS regional office. The role of the NHS regional office is not always benign. I am told that regional offices rang CHC staff to tell them that they would be in breach of their contracts of employment if they did anything to support ACHCEW's lobby of Parliament on the future of CHCs.
	Similarly, if the regional offices performance manage either CHCs or the new structures, the question arises: what is considered to be good performance--one that makes waves for the local NHS or one that is helpful and supportive? My own strongly-held view is that the proposed national organisation should have that role. That brings me to the proposed national organisation because there is nothing in the Bill about it. The Bill proposes the abolition of my former organisation, ACHCEW, but makes no provisions for a national overview of patient representation and involvement. ACHCEW is and was the national body representing patients' interests. It plays a key role in consultation with Government and with leading health professional and regulatory bodies. It also runs high profile monitoring campaigns such as Nationwide Casualty Watch and produces a range of publications for lay representatives and patients.
	There is a clear requirement for a national body to take on a range of functions, including the training of staff and volunteers, exchange of best practice, establishing performance standards and the provision of expert advice, research and publications. Without such a body there will be significant inconsistencies in the quality of patient empowerment and public involvement throughout the country. Variability is the main charge that Ministers have levelled at CHCs to justify their abolition. It is ironic that the Bill as currently drafted, which introduces a plethora of bodies but without a national co-ordinating body, has patchiness built into it. The public has a right to the same standards of representation regardless of where they live. A government that opposes postcode prescribing should not seek to introduce postcode representation. In order to get a genuine overview of problems in the NHS the public needs a national body.
	In the Second Reading debate in the other place the Secretary of State announced that the department would be funding work to look at the feasibility of forming a national patients' organisation to act as an independent umbrella body for NHS patients. However, that scoping study will not be completed until the end of next month. There are no guarantees that a new body will be established. Even if the report were to recommend it, the Government have apparently ruled out statutory status. That is a wrong judgment. Statutory status is needed to ensure its independence and protection from changing opinion within the Department of Health. Without it, any national body would be liable to abolition or loss of funding without parliamentary debate.
	I have always believed that CHCs need to change and be reformed; certainly, I said as much repeatedly when I was director of ACHCEW, which did not always enhance my popularity with some of the CHCs, particularly those most in need of change. But the NHS Plan as initially described was, at least as far as concerned CHCs, not about reform and could have left patients with a deeply flawed representative structure. The Bill as now amended is very different; indeed, the arrangements proposed are almost robust and make sense. It will not take much to get them right, and I hope that that happens before the Bill leaves your Lordships' House.

Baroness Northover: My Lords, we share the Government's welcome commitment to the NHS, but we also agree that the NHS needs to change and move on. Patients have a right to expect a high quality service with equality of access to provision wherever they live. Will this Bill help to achieve that? This is a complex measure which rushes to the wire. If there is an election in April the Bill will not pass into law; even with a May election things will be very tight. There is very little time for detailed analysis of how the provisions will work, yet they may have an effect for years to come.
	As my noble friend Lord Clement-Jones explained, we welcome some of the provisions of the Bill. However, there are a number of areas which concern us and, clearly, other noble Lords as well. Our concerns focus on three main areas. The first is the missed opportunity to cover personal as well as nursing care for those in residential care. The second is the astonishing abolition of community health councils without adequate, let alone improved, replacements. The third centres on the Bill's proposals for the handling of patient information. Other issues also concern us, some of which I shall mention. However, I shall focus most of my remarks on those three areas. In failing to adopt the Royal Commission's recommendations that personal as well as nursing care should be free the Government impoverish those who receive such care, cause confusion and place those who look after them in an impossible situation. The NHS was set up to help alleviate the burden of poverty on those who had the misfortune to fall ill. Surely, in the same way we should seek to help, not penalise, the most frail, as the noble Baroness, Lady Greengross, put it.
	As my noble friend Lord Clement-Jones and many other noble Lords have said, it is wholly illogical to maintain a division between nursing and personal care. How invidious it will be for the poor nurse who must arbitrate here, thus undermining his or her relationship with those for whom he or she cares. If he or she changes a dressing it is free; if a care assistant does it, no doubt a form will need to be filled out so that it is paid for.
	The RCN's definition of nursing quoted tonight by the right reverend Prelate the Bishop of Lichfield included bathing, feeding, toileting and comforting, which I somehow believe is not the Government's definition of "nursing care". Meanwhile, Scotland looks set to abandon the division between nursing and personal care. The Welsh Assembly, too, has signalled that it would wish to consider doing the same if only it had the power to do so. Surely that is an area, on the basis both of fairness and workability, that must be re-examined.
	We do not share the Doomsday scenario of the noble Lord, Lord Lipsey. This proposal is fully costed in our alternative Budget. I would commend that to the noble Lord.
	The second issue is the abolition of CHCs. Tonight there has been overwhelming opposition by noble Lords to that. On these Benches we are astonished and alarmed at the plan to abolish CHCs without adequate and more effective replacement. Surely, we all agree that the health service must work in partnership with patients and not act as a paternalistic body. The Minister said that patients must have more say. The Secretary of State made the point in another place that patients need a complaints system that is accessible, open and independent. He said that they need helping through it and they need also to be able to assess the performance of their local health service. Yes, indeed; but if that is so why propose this fragmented system? A system that the noble Earl, Lord Howe, rightly called a mishmash and the noble Baroness, Lady Fookes, described as a hydra.
	I agree with the noble Baroness, Lady Ashton, that patients must be heard. But this proposal with all its different elements in different settings, semi-independent with few teeth, with no costings and with a complaints system which is waiting on a report from the department of health? Not only does the proposal destroy the watchdog role of the CHC, it removes the only real assistance there was in the complaints procedure.
	A complaints procedure must be transparent, independent, simple to understand and cover all aspects of care. Above all, it has to be seen from the patient's point of view. How on earth can patients, unfamiliar with health trusts, patients' self-selecting forums, PALS, scrutiny committees and so on, possibly hope to feel that they know how to take a complaint through?
	I remember when I was on a family practitioner committee how inadequate the complaints system seemed. Now we have a rising tide of legal challenges to medical practice with a huge financial price tag attached. Surely where it is possible for a patient to feel that he or she is being listened to, we should devise systems with their viewpoint in mind, not the chief executive of the trust or the Secretary of State or anyone else from within the system?
	At least being pointed to a CHC for help was a step on the way. Where is the one-stop shop in this proposal? CHCs may need reform, but babies and bathwater do indeed come to mind. To be charitable, I might conclude that the Government may have plans, but that they are not ready. Otherwise, these are astonishing proposals.
	The third issue is that of patient information. It has to be a cause for concern when the GMC indicates that the supply of patient information may breach patient confidentiality, while the cancer registries fear that they will not receive data that they need and medical charities and pharmaceutical companies say that data are essential to their effectiveness. All agree that the Secretary of State is taking powers that are far too wide-ranging.
	There is clearly a balance to be worked out on confidential patient information between the right of the patient to confidentiality and the need for patient information by cancer registries and others to conduct research in the public interest. I have no doubt at all that the vast majority of patients are only too happy that others should benefit from their experiences. I therefore note with great concern the letter from Sir Donald Irvine, President of the GMC, and others in The Times of 7th February of this year in which they state that,
	"any decision to override the citizen's right to privacy should be exceptional and must only be made--other than in an extreme medical emergency-- after rigorous parliamentary scrutiny rather than by order of a Secretary of State".
	The GMC now seeks to see proposed regulations on the face of the Bill. I note what the noble Lord, Lord Rea, had to say on that.
	On anonymised data, sympathise though I might with a Secretary of State who does not wish to see NHS costs driven up by the pharmaceutical industry, I am very concerned again at the powers he intends to take. Too much discretion in the Secretary of State's hands could prove a temptation in areas where there is conflict of interest; for example, in whether to allow into the public domain anonymised data that would reflect poorly on the Government's performance. That kind of decision is far better held in independent hands.
	On the subject of medical research and public health, I take very seriously the fact that the noble Lord, Lord Turnberg, is not yet comfortable with this clause. I trust that when we have passed amendments he will indeed be comfortable.
	Besides these three key areas, a number of issues have come up in the debate today. We give a cautious welcome to the traffic light system for hospitals, but could not the department have come up with a happier way of describing hospitals that are not coming up to scratch? What are patients to make of their hospital suddenly becoming a red light hospital?
	We also give a cautious welcome to care trusts, since we have long advocated better integration between health and social services. But we note the concern expressed by various organisations about an unequal partnership. Malcolm Dean in the Guardian on 14th February described care trusts as potential "Trojan horses" unless that partnership is equal: social services must not simply see their resources drained by the acute needs of a dominant NHS.
	In summary, it does seem to me that it is in those areas where the Government should be listening to patients that we have most problems with the Bill. And that is over personal care, ensuring that the patient's voice is heard, and in the use of their own information. The NHS is for patients; it is for the public.
	I trust that over the next month or so the Government will address the questions that remain to be answered. As the Government try to get the Bill on the statute book before the election, I trust that we will not entrench avoidable problems in a health service that could well do without them.

Lord Astor of Hever: My Lords, this debate has been of very high quality and characteristically well informed. That is not surprising, given the knowledge and experience of so many eminent speakers. The noble and learned Lord, Lord Archer, felt that he was intruding into health matters away from his normal subjects. I very much enjoyed his speech and hope that we will hear much more from him in the future on health matters.
	The Government fought the last election on a promise to save the NHS. The health service would see dramatic improvements under their stewardship. But waiting lists are higher, the number of nurse vacancies stands at 20,000 and the NHS is in almost year-round crisis. Official Department of Health figures reveal that only 110 extra family doctors were recruited last year. The BMA has described this as a disaster and has warned that patients' lives will be put at risk unless the Government change their policy to take account of this recruitment crisis. What is the reaction of the Government? "We just do not seem able to get Ministers to listen", said the deputy chairman of the GPs' committee of the BMA. "They seem absolutely bent on ignoring everything we say".
	The Government also ignored much of what honourable Members wished to say at the Report stage of the Bill in the other place. Many amendments were not debated or received only scant consideration. Some 15 pages of government amendments were tabled to what was an 80-page Bill. More to the point, the Government tabled those amendments at the last possible moment. As a result, it was virtually impossible for Members to consult with the many outside bodies interested in the Bill. Accordingly, it is the responsibility of your Lordships' House to rectify this. I trust that we shall be given sufficient time properly to scrutinise the Bill.
	We on these Benches regard the Bill as something of a curate's egg, good in parts but bad in others. As my noble friend Lord Howe pointed out, there are aspects of the Bill which we very much welcome. Given the time constraints and the sheer length of the Bill, I can touch on only a few areas which are causing us, along with many organisations that have written to us, the most concern. We are concerned that the Government's policy objectives, set out in the NHS Plan, could be stifled by over-prescriptive target setting and a centralised bureaucracy within the NHS. After all, the NHS is an organisation of over 1 million people and accounts for almost 6 per cent of GDP. The Government's belief that such a vast and diverse entity can be centrally controlled and managed effectively from a single Minister's desk is dangerously misguided. My noble friend Lady Carnegy made that point very well, as did my noble friend Lady Noakes so persuasively in her contribution to the debate on the Address.
	At the heart of the Bill lies the Government's proposal to abolish, arbitrarily and without any consultation, the only independent voice of patients and communities, the community health councils. This has been received with almost unanimous rightful indignation from all parts of this House tonight and the other place. My noble friend Lady Fookes and the noble Baroness, Lady Masham, spoke eloquently of the disruption that will be caused by the changes. The BMA has voiced its severe reservations, as did the National Association of Citizens Advice Bureaux, MIND, the King's Fund, the Royal College of Nursing and the Law Society. Numerous other letters of concern and critical briefings are piled high on my desk, many from within my own county. South East Kent CHC played a pivotal role in the exposure of Rodney Ledward.
	Despite Clauses 13 and 17 being incorporated into the Bill in the other place, our concerns about the Government's proposals remain very strong. The Government are riding roughshod over the concerns of patients and professional bodies. While we do not expect the Government to listen, we do feel that they should be made fully aware of the strength of feeling on this matter. We hope, therefore, that the Government will now drop their plans to scrap the CHCs and will instead resource and improve them. In the meantime, I very much echo the question put by the noble Lord, Lord Clement-Jones, as to the real cost of the CHC replacement.
	Many noble Lords mentioned care trusts. While a cautious welcome has been extended to voluntary establishment, organisations such as the BMA and the RCN are concerned about the compulsory creation of a care trust against the wishes of local bodies and individuals. We shall want to return to several aspects of this in Committee, in particular to the issues of by whom and by what means the process for assessing and deciding upon failed performance will be triggered; the criteria for inadequate performance; and what kind of resources and support will be available for care trusts where they are imposed as a result of a failing categorisation. We shall also wish to explore how progress will be monitored and what will happen if it is not satisfactory.
	My noble friend Lord Howe welcomed the extension of prescribing rights to a wider range of health professionals. Here I pay particular tribute to my noble friend Lady Cumberlege, who is not able to speak in the debate through illness. She has long been a champion of nurse prescribing.
	I should like clarification from the Minister on two points. First, there must be absolute clarity about who retains clinical responsibility. Will those with prescribing rights be independent of existing prescribers such as GPs and consultants or will they be dependent on an existing prescriber who would take ultimate responsibility for the decision? Secondly, can the Minister confirm that any advisory body created to consider and advise Ministers on the award of additional prescribing rights will include representatives of relevant professional groups, including doctors, nurses and pharmacists?
	The noble Baroness, Lady Ashton, touched on performance grading for access to supplementary funding--the traffic light proposals to evaluate NHS bodies. The King's Fund, among others, has raised a series of concerns about this approach to evaluation and funding. It may make evaluation more simple but it could well lead to some bodies being unfairly treated. In particular, bodies labelled as "red" or "failing" are likely to have a severe impact on patient confidence and staff morale, which, as my noble friend Lord Howe said, is very low at the moment.
	The RCN also does not believe that it is right for a quota of NHS bodies to be determined in advance. The organisations categorised as "green", "yellow" and "red", should be determined on merit, rather than having a system whereby a certain proportion of organisations would be bound to be categorised as failing each time.
	Clause 20 allows the Secretary of State to intervene in poorly performing NHS organisations. These are considerable powers and the Opposition believe that they should be used only in the most serious or extreme circumstances. We shall want to question in Committee how an intervention order will be brought to an end and whether the bodies with interim control will be informed of clear targets before autonomy is returned.
	Many noble Lords were worried about Clause 67, which was tacked on to the end of the Bill and is well beyond the Government's proposals outlined in the NHS Plan. This clause was rushed through the other place without consultation with any interested groups, including patients, doctors and medical researchers. Groups ranging from medical charities to professional bodies have expressed their deep concern at the sweeping powers which the Secretary of State will secure over the use of identifiable and anonymised patient data. Despite some minor amendments in the other place--albeit not on the face of the Bill--this clause is profoundly objectionable in form and substance. It would cast a very wide net over many medical, research and other currently legal activities, and I hope that the Government will think again.
	Many noble Lords mentioned the extension of free nursing care to residents of nursing homes, which, as my noble friend Lord Howe said, we welcome. However, the RCN is extremely concerned at the very narrow definition of nursing care that the Government are using and propose to fund. This concerned my noble friend Lady Fookes and the noble Baroness, Lady Wilkins, among others.
	The Government's definition excludes nursing care provided by healthcare assistants, but they deliver much of the nursing care received by frail older people in nursing homes, as was so eloquently portrayed by the two right reverend Prelates. I hope the Minister will address this important point in his reply.
	My noble friend Lady Hanham was concerned about possible conflicts of interest when members of the patients' forums are appointed as non-executive directors of their trust board. This is an important point and I look forward to the Minister's response.
	The noble Lord, Lord Rix, fresh from his valiant efforts on the Special Educational Needs and Disability Bill, made some excellent points about people with learning difficulties. As the father of an autistic daughter, I fully support the noble Lord's wish for a place for them in dental, pharmaceutical and community services.
	We on these Benches are adamant that proper, robust scrutiny of the Bill is essential. We share many of the varied and legitimate concerns expressed tonight and look forward to returning to them constructively in Committee.

Lord Hunt of Kings Heath: My Lords, I agree with the noble Lord, Lord Astor, that this has been an excellent and wide-ranging debate. It has encapsulated both the ambitious nature of the Government's plans for the NHS and social care. It has also identified many of the key challenges that we face.
	Many points have been raised. I shall attempt to deal with the key points; and I have no doubt that in Committee, as noble Lords have threatened, we shall deal with the others in ever-loving detail. Indeed, I noted that most noble Lords welcomed the Bill in about 10 seconds, and then proceeded to spend the rest of their speeches attempting to demolish bits of it. Although there is clearly disagreement among noble Lords over some aspects of the Bill, we start from a foundation where there is broad support for many of the aims contained in it. That is a healthy foundation on which to move.
	I begin with the important issue of support and care for older people. The matter has exercised your Lordships on many occasions, and it is one in which I have a great deal of interest. Although it has been claimed in the debate that the Government's decision with regard to nursing care and personal care will lead to discrimination, the fact is that from October this year anyone who is already paying for his or her own nursing care in a nursing home or who is considering a move to a nursing home can approach their local health authority or primary care trust and ask for their nursing needs to be assessed and paid for by the NHS. That is surely a major advance and needs to be seen as such.
	I have listened again, as I did some weeks ago, to the calls for personal care to be made free. The Government's position has not changed. We believe that the extra resources that we are bringing should be spent so as to benefit as many older people as possible. We are spending £1 billion on health and social services for older people across the board. We believe that the targeting of public money at a larger number of older people, preventing them from having to go into residential care in the first place and investing in intermediate care, will at the end of the day provide a more effective range of services for many more older people than free personal care would provide.
	The noble Baroness, Lady Barker, made references to intermediate care. I believe that what we are proposing to undertake is providing, and will provide, an enormously wide range of care and services that will promote independence and improve the quality of care. At the end of the day, when it comes to a choice of provision of intermediate care services or free personal care, I believe that the provision of intermediate care services, with all that that means about promoting independence and the rehabilitation of people, is the right way to spend our resources.
	A number of speakers, the noble Baroness, Lady Fookes, in particular, believe that it is unworkable to make a split between nursing care and personal care. I have to say that the split between NHS and personal social care provision has been a feature of our welfare services for many years. The Royal Commission believed that it is possible to distinguish between nursing care and personal care. The improved procedures that we are developing for assessing nursing requirements and the input of registered nurses are being developed with several organisations, including the RCN, Help the Aged and the Alzheimer's Disease Society.
	The assessment of an individual's current and future nursing care needs will be undertaken by NHS nurses, using a standard approach as part of a single, multidisciplinary assessment. The assessment tool for this purpose will be published as part of the national service framework for older people. The aim is to ensure that nursing care is free wherever it is received. The definition that we have used clearly covers all care that requires the skills and experience of a registered nurse. Far from being discriminatory, surely that is a clear, fair and capable definition that can be applied on a consistent basis. Indeed, all the alternative definitions that have been proposed begin to break down the distinction between free nursing care and free personal care, either for care delivered by certain groups or to certain patients.
	When a person's need is primarily a health need defined by continuing care criteria, all his or her care in a nursing home is funded by the NHS in the same way as applies in a hospital. However, for the vast majority of nursing home residents, where their need for nursing care is additional to their need for accommodation and personal care, the intention is to provide free nursing care in nursing homes in the same way as it would be provided in a person's own home or in a residential home where personal care is provided by carers or care assistants and the registered nurse provides nursing expertise. In those settings, bathing, feeding, dressing and toileting are provided by carers, either paid or unpaid, and, where applicable, charged for after a means test. The definition at which we have arrived most closely represents the extra care received in a nursing home compared to a residential home--that is, care provided by a registered nurse with her experience and skills.
	Surrounding this debate is very much the issue of the overall care for older people. The right reverend Prelate the Bishop of Lichfield referred earlier to age discrimination, as did the noble Lord, Lord Clement-Jones. Perhaps I may make this abundantly clear, as I have done previously in this House. There is no place for age discrimination in the National Health Service. The national service framework, which I can assure the noble Baroness, Lady Barker, will be published soon, will address these issues with great care.
	I have paid a great deal of attention to the issues raised by my noble and learned friend Lord Archer of Sandwell in relation to dementia and, indeed, to the points raised by the noble Lord, Lord Rix, regarding learning disabilities. I have a great deal of sympathy with the view that these are major health and social care issues which must be tackled. But what I cannot agree with is that one can decide that one can provide free personal care for some category of provision in relation to different groups such as people suffering from dementia or people suffering from learning disabilities and not for other categories. I think in the end it would prove to be very difficult to draw such a distinction.
	I believe that making personal care free for everyone would not necessarily improve the quality of services; it would not help the least well off. I believe that investment in intermediate care is the most appropriate way to use the increased resources that we have available alongside what I believe to have been a very good decision in relation to free nursing care.
	A number of questions were asked about preserved rights. I make it clear that £86 million extra will be available to local authorities on top of the current costs to the Department of Social Security of the preserved rights scheme. That is in recognition of the way preserved right funding has fallen behind the cost of local authority packages of care in recent years.
	I turn to the issue of patient information. I assure the noble Earl, Lord Howe, and the noble Lord, Lord Astor of Hever, that the powers in the Bill to allow the use of patient confidential information without consent are intended to be used only to safeguard the continued operation of key services that are in the patient and public interest and cannot be carried out by other means. Indeed, those safeguards are built into the Bill. But, as the noble Lord, Lord Clement-Jones, pointed out, the GMC guidance which comes into operation in October would not permit the use of patient information without consent.
	The proposals in the Bill are not a long-term solution to the use of patient information. We agree with the GMC that the only sustainable base for the use of patient confidential information is informed consent. As the technology becomes available to allow the use of anonymised data, we shall be able to move away from the use of confidential information in many areas. But this is not the every day experience in the NHS today. It will take time to move the culture and processes of the NHS on to a proper use of informed consent. The powers in the Bill will allow key services to continue to use patient information in the meantime, protecting the work of cancer registries and others.
	I say to my noble friend Lord Rea that we do not accept that a list of all the uses of patient information without the need for consent can be drawn up in Whitehall and written into the Bill. One simple argument against this approach is that the list will change. New technology will allow some services to move to anonymised data. A central list is also bound to miss out key services. That is why we propose that individual uses of information are identified in regulations once they have been through a rigorous and transparent series of safeguards to make sure that the use of the powers in the Bill are appropriate. These safeguards include an expert advisory committee to advise the Secretary of State. A proposal will have to be in the patient or public interest. There must be no other reasonably practical alternative to using patient information without consent. The Secretary of State must consult before laying the regulations. The regulations will have to be made under the affirmative procedure, debated and voted on in both Houses. Once in place, the Secretary of State is required to review the regulations on an annual basis to ensure that they continue to meet these criteria.
	This approach allows the medical community to identify the uses; disease registries, medical research, and public health, and then subject proposals to rigorous tests before the use of the power. These are clear, transparent safeguards; a process that allows the NHS the opportunity to identify the use of patient information but at the same time a process that the Data Protection Commissioner recognises as safeguarding patients' rights.
	I turn to the outlawing of the use of anonymised data for commercial purposes. The powers in the Bill allow the Secretary of State to make regulations controlling the release or processing of patient or patient derived data for commercial purposes. I stress the term "commercial purposes". We believe that those powers are necessary to prevent the use of this information in ways that are to the detriment of the NHS. A prime example is the recent Source Informatics case where a data processing company was using prescribing data to target marketing efforts and drive up drugs costs--a process that would not be beneficial to patients or the NHS. The Bill provides the Secretary of State with the powers he needs to stop that kind of activity.
	But we have sought to reassure the pharmaceutical industry that our concern is with the use of information for targeted marketing which would unnecessarily increase the burden of NHS finance. That would not be done without consultation. Regulations would have to be brought forward; and any action would be targeted and focused.
	On the issues raised by my noble friend Lord Turnberg, anonymised data can be used for any purpose unless it is a specific purpose which the Secretary of State has prevented by regulations under Clause 67. I understand some of the concerns he raised, particularly those concerning the Public Health Laboratory Service. I understand that the definition of medical purposes is broad enough to encompass all the important public health work undertaken by the PHLS. I am happy to discuss this matter with him further between now and the next stage of the Bill.
	I turn to care trusts. I believe that these are an important mechanism to bring together health and health-related local authority services to deliver integrated care to local people. I want to respond to many points raised, in particular by my noble friend Lord Harris, on whether it is a true partnership. It is a true partnership; it is not a takeover by the NHS. The importance of the local authority is protected by the process for establishing a care trust. All local partners must agree that a care trust is the right approach. Local authority members will be guaranteed representation on the care trust's board. The local authority retains overall responsibility for the functions delegated to the care trust. The care trust will be accountable to the authority. Any of the partners can apply to withdraw from the care trust.
	Perhaps I may say to my noble friend Lady Wilkins that I understand the fear that a care trust would operate under the philosophy of a medical model as opposed to a social model. I believe that the involvement of local authorities in such a positive partnership way would ensure that one would involve the best of a social and medical model of care so that one was able to provide a more co-ordinated and integrated set of services. Of course, a local authority would have to give its agreement and support for a care trust to be formed. Surely that is one of the issues which a local authority would bring to the table.
	On funding and payment for services, perhaps I may say to the noble Baroness, Lady Masham--I think that it is clear from what I have already said in relation to nursing and personal care--that the Government remain committed to the principle that NHS care should be free at the point of delivery. In relation to care trusts, a local authority would remain responsible for the charging policy of those services on which it has discretionary powers. When people are assessed for a range of services, they clearly will need to be informed for which of the services they would be charged. That means that clear information will need to be given to users and appropriate training to staff.
	Many noble Lords raised the issue of community health councils. I have to confess that I was one of the first community health council secretaries ever appointed, back in 1975. I shall be for ever grateful for that experience. There is no doubt that CHCs were a much-needed jolt to a rather complacent National Health Service. I certainly agree with the noble Earl, Lord Listowel, that many CHCs, their staff and members, have done sterling work over those years.
	The noble Earl, Lord Howe, asked about the record of CHCs. Looking back over the past 25 years, I do not believe that they have fulfilled all that was hoped for from them. The noble Baroness, Lady Fookes, raised the same question. Fifty two years after its formation, the National Health Service still exhibits too many characteristics of a producer-led philosophy. There is still too much paternalism towards the users of its services, it is still too slow to deal with patients' concerns on the spot, and it is still not open to sufficient local scrutiny on major changes of services.
	That is where our proposals come in. Far from stifling or inhibiting user involvement or patient representation, we are enhancing it and giving it a much bigger punch than it has ever had before. That is the test on which our proposals must stand or fall.
	I first came across the system of patient representation in the United States 15 years ago. I have always been impressed with the fact that hospitals in the US have members of staff whose job is to deal with problems for patients the moment that they arise. The patient advocacy and liaison service will be very effective in sorting out issues immediately rather than letting them gestate, ultimately forcing people to go through what we all agree can often be a very bureaucratic complaints service.
	In our proposals in the Bill and the plan, we have recognised the need to ensure the independence of patient representatives, but they also reflect the important need to ensure that the patient's voice is heard in the NHS and to bring about change. We need to strike a balance between independence and influence. In some cases it is clear that independence is paramount. That is where the independent patient advocacy service comes into play, enabling support to be given to complaints, independent of the body about which the complaint is made. We have recognised the importance of requiring independent advocacy services to be established across the country for the first time. I agree that it is also important that people should not have to go through the PALS service to get access to that independent advocacy service. I assure noble Lords that approaches can be made directly. We also believe that NHS Direct will have an important role to play.
	Patients' fora--if I may use the word--will have a positive role in bringing the concerns of patients to the attention of the board of NHS trusts. I listened very carefully to the questions of the noble Baroness, Lady Hanham, about the role of the non-executive director. I do not share her concerns about a person appointed through the patients' forum also serving as a corporate member of the board. The health service has a happy history of people wearing more than one hat on the boards of NHS trusts, including local authority councillors and, dare I say, doctors. It will be possible to make the arrangements work effectively.
	We shall develop our ideas on the appointments process, but the independent appointments commission will have a role in overseeing the arrangements. We shall need to come to the issue that the noble Baroness has raised about the number of non-executives on the board.
	The noble Earl, Lord Listowel, and my noble friend Lord Harris referred to a national patients' body. We have listened to the calls from patient groups which press the need for a national patients' body. We also recognise the need for a body to provide support, guidance, training, development and public representation in relation to patient care. Following a proposal from leading patients' organisations, we are funding a feasibility study about how such a national body would work in practice. We shall look to develop any proposals which emerge from that project.
	I sense that my time is nearly up. Perhaps I may conclude by commenting on the suggestion that the Bill is rather centralist, as the noble Earl, Lord Howe, said. The debate about central and local direction in the health service has been with the NHS since its formation in 1948. The government of which the noble Earl had the honour to be a member dabbled in this matter. I remember that at one stage during their stewardship, they managed to produce 57 different priorities for the NHS. They had a record of continuous restructuring, and they gave us the internal market, which produced an enormous bureaucratic overload.
	However, despite that, the NHS was left with a great deal of inconsistency, with postcode rationing and with a slow take-up of new medicines, technology and treatment. We introduced mechanisms such as NICE, the Commission for Health Improvement and National Service Frameworks in order to achieve greater consistency.
	I believe that the new powers in the Bill are wholly in line with the aim for consistency; for example, Clause 6 seeks to direct trusts in relation to the terms and conditions of employment of staff. That is necessary in order to implement consistent pay modernisation across the NHS. Clause 20 seeks to create new powers which will allow the Secretary of State to replace management teams in the NHS in cases of extreme failure. Alongside the power to enforce the coming together of NHS local authorities as care trusts, both those provisions are backstop measures to be used only as a last resort. However, the NHS cannot and should not sustain failure. I believe that it would be irresponsible of us not to introduce measures to improve performance where there is clear evidence of problems.
	It is important that the Bill also recognises the benefit of local leadership and ownership. That is crucially important in relation to earned autonomy. The NHS must be rewarded with few strings attached to successful organisations but with more intervention in the case of those which fail to keep up with the level of the best. Surely that is the answer to the perennial issue of striking a balance between central and local control in the National Health Service--that is, to provide the incentives for organisations that perform well to be given more freedom and to intervene more with the weaker organisations.
	There are other ways in which to push down responsibility; for example, by giving health authorities more control in relation to the suspension and distribution of GPs. Local pharmaceutical services will depend on the leadership role from health authorities. At the same time, primary care trusts will take on more and more responsibility for the commissioning of services, and an independent appointments commission will take over from Ministers responsibility for appointing non-executives. I do not accept the charge that the Bill is over-centralising. I consider that it provides a sensible balance between national consistency and local ownership.
	In conclusion, we have had an excellent debate which no doubt will be continued in Committee. I believe that the Bill represents an important plank in our armoury of establishing NHS and social care services as a beacon for excellence in our society today. We face enormous challenges in transforming those services, and I believe that the Bill will help us on the way.

Lord Rix: My Lords, before the noble Lord sits down, perhaps I may ask one question. Why does he find it so difficult to place those with severe mental impairment in one category and to say that they are not worthy of being deemed as in need of nursing care as opposed to other categories which are perhaps less severe? I refer to people with cognitive impairment caused by, for example, strokes, Alzheimer's, learning disability, dementia or Huntingdon's disease. Surely it would be fairly easy to deem all of those people as being in need of nursing care wherever they may be living and simple to separate them from other categories of disablement.

Lord Hunt of Kings Heath: My Lords, I was trying to make two points. First, when I discussed enabling free nursing care to be provided in nursing homes, I tried to point out that there is consistency of approach between nursing services that are provided in residential care homes, which are currently provided free by the district nursing service, and that provided in people's homes. The Government have decided that there should be complete consistency with regard to the provision of registered nursing care through all of those sectors. Secondly, in the context of today's debate--we shall doubtless discuss this further in another context--if one seeks to establish whether there are categories of people who should be given free personal care, one runs into great difficulties trying to distinguish between people with dementia or learning disabilities, for example, and the other care categories that may be involved. That is why I believe that ultimately the right distinction is that between nursing and personal care. That is the Government's approach.

Lord Archer of Sandwell: My Lords, before my noble friend concludes his remarks, and at the risk of being tiresome, does he accept that there is not only a distinction between nursing care and personal care but that other forms of treatment could be involved? Although such forms of treatment are not administered by registered nurses they are nevertheless as much treatment as nursing care.

Lord Hunt of Kings Heath: My Lords, if we are considering treatment, that would be provided by the NHS under the provisions of the National Health Service Act. However, in this context we are concerned not with care that is provided in homes--a primary health need, as that is defined by continuing care criteria--for, in that case, all such care would be funded by the NHS. Rather, we are concerned with the situation in which the need for nursing care is not continuing care but care that is additional to the need for accommodation and personal care. In that context, the Government's proposals involve a consistent approach across nursing home care, residential care and district nursing that is provided to people in their homes.
	On Question, Bill read a second time, and committed to a Committee of the Whole House.

House adjourned at twenty-eight minutes past eleven o'clock.